TY  - JOUR
T1  - FIB-4 INDEX IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM: A CASE-CONTROL STUDY
TT  - Primer Hiperparatiroidizm Hastalarında FIB-4 İndeksi: Bir Vaka-Kontrol Çalışması
AU  - Önder, Çağatay Emir
AU  - Gökbulut, Püren
AU  - Taşkaldıran, Işılay
PY  - 2026
DA  - August
Y2  - 2026
DO  - 10.24938/kutfd.1955821
JF  - The Journal of Kırıkkale University Faculty of Medicine
JO  - Kırıkkale Uni Med J
PB  - Kırıkkale Üniversitesi
WT  - DergiPark
SN  - 2148-9645
SP  - 341
EP  - 350
VL  - 28
IS  - 2
LA  - en
AB  - Objective: Although the target organs for primary hyperparathyroidism (PHPT) are the renal and skeletal systems, hyperparathyroidism has also been linked with metabolic syndrome as well as non-alcoholic fatty liver disease (NAFLD). This study aimed to evaluate metabolic parameters, and the fibrosis-4 index (FIB-4) among patients with PHPT. Material and Methods: This study included 30 patients with PHPT and 30 healthy controls. FIB-4 index was calculated for all participants whose metabolic parameters were recorded. In addition, according to the FIB-4 index, participants were divided into low and medium-high risk categories for fibrosis using a cut-off value of 1.3. The participants’ metabolic parameters and the FIB-4 indices were compared. Results: PHPT patients had a median age of 58 years (25–65), and 90% of them were female. Metabolic parameters (fasting plasma glucose, homeostasis model assessment of insulin resistance [HOMA-IR], and lipid parameters) did not vary across the groups (p>0.05). The PHPT group had a FIB-4 index value of 0.99 (0.36–1.51), and the control group 0.66 (0.41– 1.57) (p=0.030). The number of patients in the medium-high risk category was higher in the PHPT group than in the control group (p=0.040). Conclusion: PHPT patients showed higher FIB-4 index values and a greater frequency of medium-to-high non-invasive fibrosis risk than controls. However, as FIB-4 is an indirect surrogate marker, these findings should not be interpreted as confirmed hepatic fibrosis. Further prospective studies using direct or imaging-based methods are warranted.
KW  - Primary hyperparathyroidism
KW  - parathyroid
hormone
KW  - fibrosis-4 index
KW  - metabolic syndrome
N2  - Amaç: Primer hiperparatiroidizm (PHPT) başlıca renal ve iskelet sistemlerini etkilemekle birlikte, metabolik sendrom ve non-alkolik yağlı karaciğer hastalığı (NAFLD) ile de ilişkilendirilmiştir. Bu çalışmada, PHPT’li hastalarda metabolik parametrelerin ve fibrosis-4 indeksinin (FIB-4) değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya PHPT tanısı olan 30 hasta ve 30 sağlıklı kontrol dahil edildi. Tüm katılımcıların metabolik parametreleri kaydedildi ve FIB-4 indeksi hesaplandı. Katılımcılar, 1,3 kesim değeri temel alınarak düşük ve ortayüksek fibrozis riski kategorilerine ayrıldı. Bulgular: PHPT hastalarının medyan yaşı 58 yıl (25-65) olup, hastaların %90’ı kadındı. Açlık plazma glukozu, HOMA-IR ve lipid profili dahil olmak üzere metabolik parametreler gruplar arasında benzerdi (p>0,05). FIB-4 indeksi, kontrol grubuna kıyasla PHPT grubunda anlamlı olarak daha yüksekti (0,99 (0,36-1,51) ve 0,66 (0,41-1,57), p=0,030). Orta-yüksek risk kategorisindeki katılımcı oranı da PHPT grubunda daha yüksekti (p=0,040). Sonuç: PHPT hastalarında, kontrollere kıyasla daha yüksek FIB-4 indeks değerleri ve orta-yüksek non-invaziv fibrozis riski sıklığı gözlendi. Bununla birlikte, FIB-4 hepatik fibrozisi dolaylı olarak yansıtan bir belirteç olduğundan, bu bulgular doğrulanmış hepatik fibrozis kanıtı olarak değerlendirilmemelidir. Doğrudan ya da görüntüleme temelli yöntemlerin kullanıldığı ileri prospektif çalışmalara ihtiyaç vardır.
CR  - Madkhali T, Alhefdhi A, Chen H, Elfenbein D. Primary hyperparathyroidism. Ulus Cerrahi Derg. 2016;32(1):58-66.
CR  - Bilezikian JP, Khan AA, Silverberg SJ, et al. Evaluation and management of primary hyperparathyroidism: Summary statement and guidelines from the Fifth International Workshop. J Bone Miner Res. 2022;37(11):2293-2314.
CR  - Kowalski GJ, Buła G, Żądło D, Gawrychowski J. Primary hyperparathyroidism. Endokrynol Pol. 2020;71(3):260-270.
CR  - Dandurand K, Ali DS, Khan AA. Primary hyperparathyroidism: A narrative review of diagnosis and medical management. J Clin Med. 2021;10(8):1604.
CR  - Modica R, Liccardi A, Minotta R, et al. Parathyroid diseases and metabolic syndrome. J Endocrinol Invest. 2023;46(6):1065-1077.
CR  - Jaroenlapnopparat A, Rittiphairoj T, Chaisidhivej N, Walker B, Charoenngam N. High parathyroid hormone level as a marker of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis: A systematic review and meta-analysis. Diabetes Metab Syndr. 2023;17(8):102827.
CR  - Bhatt SP, Nigam P, Misra A, Guleria R, Qadar Pasha MA. Independent associations of low 25 hydroxy vitamin D and high parathyroid hormonal levels with nonalcoholic fatty liver disease in Asian Indians residing in north India. Atherosclerosis. 2013;230(1):157-163.
CR  - Powell EE, Wong VW, Rinella M. Non-alcoholic fatty liver disease. Lancet. 2021;397(10290):2212-2224.
CR  - Yang X, Xia M, Chang X, et al. A novel model for detecting advanced fibrosis in patients with nonalcoholic fatty liver disease. Diabetes Metab Res Rev. 2022;38(8):e3570.
CR  - Xu XL, Jiang LS, Wu CS, et al. The role of fibrosis index FIB-4 in predicting liver fibrosis stage and clinical prognosis: A diagnostic or screening tool? J Formos Med Assoc. 2022;121(2):454-466.
CR  - Kanis JA, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019;30(1):3-44.
CR  - Bilezikian JP. Primary hyperparathyroidism. J Clin Endocrinol Metab. 2018;103(11):3993-4004.
CR  - Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43(6):1317-1325.
CR  - Xiao G, Zhu S, Xiao X, et al. Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: A meta-analysis. Hepatology. 2017;66(5):1486-1501.
CR  - Reis JP, von Mühlen D, Kritz-Silverstein D, Wingard DL, Barrett-Connor E. Vitamin D, parathyroid hormone levels, and the prevalence of metabolic syndrome in community-dwelling older adults. Diabetes Care. 2007;30(6):1549-1555.
CR  - Bilezikian JP, Bandeira L, Khan A, Cusano NE. Hyperparathyroidism. Lancet. 2018;391(10116):168-178.
CR  - McCarty MF, Thomas CA. PTH excess may promote weight gain by impeding catecholamine-induced lipolysis-implications for the impact of calcium, vitamin D, and alcohol on body weight. Med Hypotheses. 2003;61(5-6):535-542.
CR  - Reusch JE, Sussman KE, Draznin B. Inverse relationship between GLUT-4 phosphorylation and its intrinsic activity. J Biol Chem. 1993;268(5):3348-3351.
CR  - Kim J. Association between serum vitamin D, parathyroid hormone and metabolic syndrome in middle-aged and older Korean adults. Eur J Clin Nutr. 2015;69(4):425-430.
CR  - Mendoza-Zubieta V, Gonzalez-Villaseñor GA, Vargas-Ortega G, et al. High prevalence of metabolic syndrome in a mestizo group of adult patients with primary hyperparathyroidism (PHPT). BMC Endocr Disord. 2015;15:16.
CR  - Al-Jehani A, Al-Ahmed F, Nguyen-Thi PL, et al. Insulin resistance is more severe in patients with primary hyperparathyroidism. Surgery. 2022;172(2):552-558.
CR  - Sun Q, Zhang T, Chen P, Tong NW, Zhang M. Glucose metabolic disorder in primary hyperparathyroidism: A systematic review and meta-analysis. Int J Clin Exp Med. 2019;12(9):11964-11973.
CR  - Luigi P, Chiara FM, Laura Z, et al. Arterial hypertension, metabolic syndrome and subclinical cardiovascular organ damage in patients with asymptomatic primary hyperparathyroidism before and after parathyroidectomy: Preliminary results. Int J Endocrinol. 2012;2012:408295.
CR  - Procopio M, Barale M, Bertaina S, et al. Cardiovascular risk and metabolic syndrome in primary hyperparathyroidism and their correlation to different clinical forms. Endocrine. 2014;47(2):581-589.
CR  - Ishay A, Herer P, Luboshitzky R. Effects of successful parathyroidectomy on metabolic cardiovascular risk factors in patients with severe primary hyperparathyroidism. Endocr Pract. 2011;17(4):584-590.
CR  - Ford ES, Li C, Zhao G. Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US. J Diabetes. 2010;2(3):180-193.
CR  - Scuteri A, Laurent S, Cucca F, et al. Metabolic syndrome across Europe: Different clusters of risk factors. Eur J Prev Cardiol. 2015;22(4):486-491.
CR  - Yamaguchi T, Kanazawa I, Takaoka S, Sugimoto T. Serum calcium is positively correlated with fasting plasma glucose and insulin resistance, independent of parathyroid hormone, in male patients with type 2 diabetes mellitus. Metabolism. 2011;60(9):1334-1339.
CR  - Castera L. Noninvasive evaluation of nonalcoholic fatty liver disease. Semin Liver Dis. 2015;35(3):291-303.
CR  - Castera L, Friedrich-Rust M, Loomba R. Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease. Gastroenterology. 2019;156(5):1264-1281.
CR  - Kim BK, Kim DY, Park JY, et al. Validation of FIB-4 and comparison with other simple noninvasive indices for predicting liver fibrosis and cirrhosis in hepatitis B virus-infected patients. Liver Int. 2010;30(4):546-553.
CR  - Zhu X, Yan H, Chang X, et al. Association between non-alcoholic fatty liver disease-associated hepatic fibrosis and bone mineral density in postmenopausal women with type 2 diabetes or impaired glucose regulation. BMJ Open Diabetes Res Care. 2020;8(1):e000999.
CR  - Jamialahmadi T, Nematy M, Jangjoo A, et al. The predictive role of parathyroid hormone for non-alcoholic fatty liver disease based on invasive and non-invasive findings in candidates of bariatric surgery. Eat Weight Disord. 2021;27(2):693-700.
CR  - Miroliaee A, Nasiri-Toosi M, Khalilzadeh O, et al. Disturbances of parathyroid hormone-vitamin D axis in non-cholestatic chronic liver disease: A cross-sectional study. Hepatol Int. 2010;4(3):634-640.
CR  - Fisher L, Fisher A. Vitamin D and parathyroid hormone in outpatients with noncholestatic chronic liver disease. Clin Gastroenterol Hepatol. 2007;5(4):513-520.
CR  - Procopio M, Borretta G. Derangement of glucose metabolism in hyperparathyroidism. J Endocrinol Invest.
2003;26(11):1136-1142.
CR  - Friedman SL, Neuschwander-Tetri BA, Rinella M, Sanyal AJ. Mechanisms of NAFLD development and
therapeutic strategies. Nat Med. 2018;24(7):908-922.
CR  - Tay DYK, Bilezikian JP. Interactions between PTH and adiposity: appetizing possibilities. J Bone Miner Res.
2024;39(5):536-543.
CR  - Amaya MJ, Nathanson MH. Calcium signaling in the liver. Compr Physiol. 2013;3(1):515-539.
CR  - Ding N, Yu RT, Subramaniam N, et al. A vitamin D receptor/SMAD genomic circuit gates hepatic fibrotic
response. Cell. 2013;153(3):601-613.
CR  - Guañabens N, Parés A. Osteoporosis in chronic liver disease. Liver Int. 2018;38(5):776-785.
UR  - https://doi.org/10.24938/kutfd.1955821
L1  - https://dergipark.org.tr/tr/download/article-file/6035660
ER  -