Coincident diabetes mellitus and primary hyperparathyroidism

Area of Science:

• Endocrinology
• Metabolic Disorders
• Calcium Homeostasis

Background:

• Primary hyperparathyroidism (PHPT) and diabetes mellitus (DM) show a higher than expected co-prevalence.
• Patients with both conditions are predominantly female and over 40, with a higher incidence of type 2 DM.

Purpose of the Study:

• To investigate the relationship between PHPT and DM.
• To understand the underlying mechanisms of insulin resistance in PHPT.
• To emphasize the clinical importance of screening for co-existing disorders.

Main Methods:

• Observational analysis of patient data.
• Review of existing literature on PHPT and DM co-occurrence.
• Discussion of proposed mechanisms for insulin resistance.

Main Results:

• Prevalence of DM in PHPT is ~8%, and PHPT in DM is ~1%, both ~3x higher than general population.
• Insulin resistance in PHPT may stem from elevated intracellular calcium impacting glucose transport.
• Parathyroidectomy showed variable success in improving glucose tolerance and diabetes.

Conclusions:

• Annual screening for impaired glucose tolerance and diabetes is recommended for PHPT patients.
• Diabetic patients should be monitored for hypercalcemia to detect PHPT.
• Early diagnosis and management of co-existing PHPT and DM are clinically significant.