Insulin secretion, insulin sensitivity and hepatic insulin extraction in primary hyperparathyroidism before and after surgery.

摘要: OBJECTIVE Primary hyperparathyroidism (pHPT) is associated with hypertension, hyperinsulinaemia, and insulin resistance. The present study investigated the causes of these metabolic disturbances by quantifying sensitivity glucose effectiveness, assessing time course β-cell secretion hepatic extraction, during a dynamic condition such as after an intravenous load. In addition, we evaluated possible link between disorders high blood pressure. SUBJECTS We studied 16 patients pHPT, before 12 weeks parathyroldectomy; eight were re-evaluated one year surgery. control group consisted 18 healthy volunteers. DESIGN AND MEASUREMENTS All subjects underwent oral frequently sampled tolerance test. data from test analysed means minimal model technique which yields relevant parameters to comprehend status single individual. RESULTS intolerance was characterized severely impaired in pHPT (3.2 ± 0.5 vs 9.5 1.5 x 104/min/(μU/ml) subjects; P < 0.001), well reduced (0.02 0.002 0.03 0.003/min 0.04). Total 4 hours almost twofold elevated comparison (32795 4769 16864 1850 pM, 0.004) its basal component significantly correlated pressure. Hepatic extraction increased (85.2 76.2%, 0.03), possibly compensatory mechanism hypersecretion, however did not prevent peripheral hyperinsulinaemia pHPT. Patients divided into two subgroups normal tolerance. had significant reduction first phase response, although their stimulated levels higher. Tissue effectiveness differ subgroups. After surgery, all biochemical (former hypercalcaemia, hypophosphataemia, parathormone levels) normalized, improved (6.1 104/min/(μU/ml), whereas remained completely unchanged. Basal responses insignificantly lowered change either. CONCLUSIONS exhibited decreased hypersecretion. latter only partially amellorated extraction. abnormalities fully reversible, changes partially.