ABSTRACT
BACKGROUND: Components of metabolic syndrome can be observed in patients with primary hyperparathyroidism (PHPT). The link between these disorders remains unclear due to the lack of relevant experimental models and the heterogeneity of examined groups. The effect of surgery on metabolic abnormalities is also controversial. We conducted a comprehensive assessment of metabolic parameters in young patients with PHPT. METHODS: One-center prospective comparative study was carried out. The participants underwent a complex biochemical and hormonal examination, a hyperinsulinemic euglycemic and hyperglycemic clamps, a bioelectrical impedance analysis of the body composition before and 13 months after parathyroidectomy compared to sex-, age- and body mass index matched healthy volunteers. RESULTS: 45.8% of patients (n = 24) had excessive visceral fat. Insulin resistance was detected in 54.2% of cases. PHPT patients had higher serum triglycerides, lower M-value and higher C-peptide and insulin levels in both phases of insulin secretion compared to the control group (p < 0.05 for all parameters). There were tendencies to decreased fasting glucose (p = 0.031), uric acid (p = 0.044) and insulin levels of the second secretion phase (p = 0.039) after surgery, but no statistically significant changes of lipid profile and M-value as well as body composition were revealed. We obtained negative correlations between percent body fat and osteocalcin and magnesium levels in patients before surgery. CONCLUSION: PHPT is associated with insulin resistance that is the main risk factor of serious metabolic disorders. Surgery may potentially improve carbohydrate and purine metabolism.
Subject(s)
Hyperparathyroidism, Primary , Insulin Resistance , Humans , Hyperparathyroidism, Primary/complications , Hyperparathyroidism, Primary/surgery , Insulin , Prospective Studies , Insulin SecretionABSTRACT
Coronavirus disease 2019 (COVID-19) is a global pandemic that is caused by a novel coronavirus, severe acute respiratory syndrome coronavirus-2. Data from several countries have shown higher morbidity and mortality among individuals with chronic metabolic diseases, such as diabetes mellitus. In this review, we explore the contributing factors for poorer prognosis in these individuals. As a significant proportion of patients with COVID-19 also have diabetes mellitus, this adds another layer of complexity to their management. We explore potential interactions between antidiabetic medications and renin-angiotensin-aldosterone system inhibitors with COVID-19. Suggested recommendations for the use of antidiabetic medications for COVID-19 patients with diabetes mellitus are provided. We also review pertinent clinical considerations in the management of diabetic ketoacidosis in COVID-19 patients. In addition, we aim to increase clinicians' awareness of the metabolic effects of promising drug therapies for COVID-19. Finally, we highlight the importance of timely vaccinations for patients with diabetes mellitus.
Subject(s)
COVID-19/immunology , Diabetes Complications/immunology , Diabetes Mellitus/immunology , Obesity/immunology , Antibodies, Monoclonal, Humanized/therapeutic use , Antiviral Agents/therapeutic use , Blood Glucose/metabolism , COVID-19/complications , COVID-19/metabolism , COVID-19 Vaccines/therapeutic use , Chloroquine/therapeutic use , Comorbidity , Diabetes Complications/drug therapy , Diabetes Complications/metabolism , Diabetes Complications/physiopathology , Diabetes Mellitus/drug therapy , Diabetes Mellitus/metabolism , Diabetes Mellitus/physiopathology , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/therapy , Dipeptidyl-Peptidase IV Inhibitors/therapeutic use , Drug Combinations , Glucagon-Like Peptide-1 Receptor/agonists , Glycemic Control , Humans , Hydroxychloroquine/therapeutic use , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Insulin Resistance , Insulin Secretion , Interferon Type I/therapeutic use , Lopinavir/therapeutic use , Lung/physiopathology , Metformin/therapeutic use , Obesity/complications , Obesity/metabolism , Obesity/physiopathology , Pancreas/metabolism , Ritonavir/therapeutic use , Severity of Illness Index , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Sulfonylurea Compounds/therapeutic use , Thiazolidinediones/therapeutic use , COVID-19 Drug TreatmentABSTRACT
BACKGROUND AND AIMS: Administration of corticosteroids is common in obstetric practice. In this concise review we queried on the effects of corticosteroids in pregnancies complicated by SARS-CoV-2. METHODS: We performed a literature search on PubMed, regarding the use of corticosteroids in patients with SARS-CoV-2 infection, in pregnancies complicated by SARS-CoV-2, as well as their impact on glycemia in pregnant women with or without diabetes. Furthermore, we searched for effects of SARS-CoV-2 and of other coronaviridae on insulin secretion and glycemia. RESULTS: SARS-CoV-2 infection appears to be a risk factor for complications in pregnancy. Corticosteroids may not be recommended for treating SARS-CoV-2 pneumonia but they may be needed for at-risk pregnancies. Corticosteroids in pregnancy have a diabetogenic potential. SARS-CoV-2 and other coronaviridae may have effects on glycemia. CONCLUSIONS: Caution should be exercised while using corticosteroids in pregnant women with COVID-19 requiring preterm delivery.