Diabetes mellitus, glucose tolerance and insulin response to glucose in patients with primary hyperparathyroidism before and after parathyroidectomy

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Abstract
In a retrospectively analyzed series of 441 patients operated for primary hyperparathyroidism (HPT), the prevalence of diabetes mellitus was 8.2%, which was three times higher than in the unselected age-matched population. Following parathyroid surgery, the need for antidiabetic treatment was unchanged. The insulin response to an intravenous glucose load was enhanced preoperatively [95 mU/l ± 41 (SD)] in twenty-six prospectively studied patients compared to postoperative (65 ± 41 mU/l) investigations (P < 0.01). This response was inversely correlated (r= 2, P < 0.01) to the serum phosphate concentrations but not related to calcium or parathyroid hormone levels. Postoperatively, most HPT patients experienced a deterioration of their glucose tolerance (t for i.v. glucose 54 ± 12 and 64 ± 21 min, respectively, P < 0.05), and one-third of them had pathological values at follow-up. Despite this, neither the fasting blood glucose levels nor the values for haemoglobin A1c were significantly affected.