Secondary hyperparathyroidism and glucose intolerance in children with uremia.

Glucose metabolism was studied using the glucose clamp technique in 8 children with CRF (4 pubertal and 4 prepubertal) before and after correction of secondary hyperparathyroidism (HPD) by a regime of phosphate binders and dietary phosphate restriction. Glucose metabolic rate (M) increased by 34%, insulin response (I) increased by 32%, and insulin sensitivity (M/I) did not change. Compared to corresponding normal values, these patients were glucose-intolerant (low M) before treatment and became glucose-tolerant after treatment (normal M). They were insulin-resistant (low M/I) before treatment and remained so after treatment. The 5 uremic children without secondary HPD were treated with the same regime to prevent the secondary HPD. Their M, I, and M/I did not change after treatment. The change in I correlated closely with the change in M in all 13 patients. One pubertal patient with uremia was studied on three occasions. Initially, without secondary HPD, he had a normal M and a low M/I. When he developed secondary HPD, M decreased by 39%, I decreased by 37%, and M/I did not change. Treatment of his secondary HPD restored M and I values back to initial levels, and M/I again did not change. Treatment of secondary HPD by correction of phosphate retention led to an improvement of glucose intolerance with an increase in insulin secretion.