Bone and Mineral Metabolism

MON-850 - Chronic PTH Elevation Fails to Induce Significant Adipose Tissue Remodeling in Primary Hyperparathyroidism

Monday, June 15, 2026

9:00 AM - 2:00 PM CT

Location: ENDOExpo; Poster Floor

Abstract Poster Presenter(s)

AN

Anda Mihaela Naciu, MD, PhD

Fondazione Policlinico Universitario Campus Bio-Medico of Rome
Rome, Italy

Senior Author/Primary Investigator(s)

AP

Andrea Palermo, MD (he/him/his)

Professor
Fondazione Policlinico Universitario Campus Bio-Medico
Rome, Italy

Co-Author(s)

AP

Andrea Palermo, MD (he/him/his)

Professor
Fondazione Policlinico Universitario Campus Bio-Medico
Rome, Italy
AN

Andrea Ninni, PhD

University of Rome Tor Vergata, Rome, Italy
Rome, Italy
LV

Luca Verteramo, n/a

University of Rome Tor Vergata, Rome, Italy
Rome, Italy
FS

Francesca Sciarretta, n/a

University of Rome Tor Vergata, Rome, Italy
Rome, Italy
LN

Lorenzo Nevi, n/a

Università Campus Bio-Medico di Roma, Rome, Italy
Rome, Italy
FL

Filippo Longo, MD

Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Rome, Italy
PC

Pierfilippo Crucitti, MD

Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Rome, Italy
AC

Anna Crescenzi, MD

Sapienza University of Rome, Italy
Rome, Italy
CT

Chiara Taffon, MD

Università Campus Bio-Medico di Roma, Rome, Italy
Rome, Italy
GT

Gaia Tabacco, MD, PhD

Fondazione Policlinico Universitario Campus Bio-Medico of Rome
Rome, Italy
DT

Dario Tuccinardi, MD, PhD (he/him/his)

professor
Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Rome, Italy
GC

Giorgia Conti, n/a

University of Rome Tor Vergata, Rome, Italy
Rome, Italy
FG

Federico Galli, n/a

University of Rome Tor Vergata, Rome, Italy
Rome, Italy
CM

Ciro Menale, PhD

University of Naples Federico II, Napoli, Italy.
Napoli, Italy
SC

Simone Carotti, MD

Università Campus Bio-Medico di Roma, Rome, Italy
Rome, Italy
FZ

Fabio Zaccaria, PhD

University of Rome Tor Vergata, Rome, Italy
Rome, Italy
DL

Daniele Lettieri Barbato, PhD

University of Rome Tor Vergata, Rome, Italy
Rome, Italy

Background
Parathyroid hormone (PTH) and parathyroid-hormone–related protein (PTHrP) exerts catabolic effects on adipose tissue in rodents, driving lipolysis, browning, and energy wasting. However, whether these mechanisms translate to human physiology remains unclear, particularly in the context of chronic PTH elevation during primary hyperparathyroidism (PHPT).

Methods
To define the impact of PTH excess on human adipose tissue, we integrated cross-species analysis with deep phenotyping of PHPT patients before and after resolutive parathyroidectomy. A synthetic forest plot compared preclinical and clinical data on PTH/PTHrP–induced adipose remodeling. In our prospective cohort, 18 PHPT patients were evaluated at baseline and 6 months after surgery alongside 9 healthy controls. We assessed biochemical parameters, circulating adipocytokines (n = 40), body composition, and supraclavicular adipose tissue transcriptomic and proteomic profiling and validation.

Results
Baseline 25-OHvitamin D levels, thyroid and renal function, did not differ between groups. PHPT patients exhibited only modest systemic alterations of adipose catabolism. Parathyroidectomy normalized PTH, calcium, and phosphorus while leaving glucose, lipid, and inflammatory markers unchanged. Adiponectin and retinol-binding protein 4 transiently increased during PHPT and returned to baseline post-surgery, whereas lipocalin 2 and thrombospondin 1 remained elevated. Body composition parameters like total fat mass, lean mass and derived indices revealed no difference in PHPT before and after surgery. No evidence of uncoupling protein 1 synthesis was detected and, furthermore, the observed phenotype is quite different from what is expected in a thermogenically-activated brown adipose tissue. Adipose tissue transcriptomics and immunostaining analysis revealed no activation of thermogenic or browning programs, confirming preserved adipose homeostasis (p-ns).

Conclusions
Despite chronic PTH excess, human adipose tissue remains resistant to catabolic remodeling, contrasting sharply with rodent models. These findings uncover a species-specific uncoupling between PTH signaling and adipose metabolism, refining current views of bone–fat endocrine integration in PHPT.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*