Primary Hyperparathyroidism Reveals Limited Adipose Remodeling in Human

BackgroundPreclinical models implicate the parathyroid hormone/parathyroid-hormone-related protein (PTH/PTHrP)-PTH1 receptor (PTH1R) axis in adipocyte lipolysis, adipose browning, and energy wasting. Whether this catabolic program is reproduced in vivo in humans remains unresolved. Primary hyperparathyroidism (PHPT), a condition of chronic endogenous PTH excess, provides a clinically relevant model to test the translational relevance of this pathway. MethodsWe combined population-scale analyses with a prospective human intervention study. PTH/PTH1R associations with body composition were evaluated in the UK Biobank and compared with PTH dynamics in cancer-associated cachexia using TRACERx proteomic data. In parallel, patients with PHPT were assessed before and after parathyroidectomy and compared with matched surgical controls. Biochemical parameters, circulating adipocytokines, DXA- and BIA-derived body composition, histology, UCP1 immunohistochemistry, and supraclavicular adipose tissue transcriptomic and proteomic profiles were integrated, with external validation in an independent supraclavicular adipose dataset. ResultsIn the UK Biobank, apparent positive associations between circulating PTH/PTH1R signals and fat or lean mass were markedly attenuated after matching for age, sex, and BMI, arguing against a disease-specific adiposity effect of PHPT. In TRACERx, circulating PTH did not increase across BMI-adjusted weight-loss grades. In the prospective cohort, parathyroidectomy normalized PTH, calcium, and phosphate but did not induce coherent changes in glucose metabolism, lipid profile, inflammatory markers, body weight, fat mass, lean mass, or thermogenic adipose signatures. Supraclavicular adipose histology, UCP1 staining, RNA-seq, proteomics, pathway analysis, and external dataset reanalysis converged on the absence of browning or thermogenic activation. By contrast, PHPT was associated with a selective adipose-related secretory phenotype: adiponectin, adipsin, and retinol-binding protein 4 were reversible after surgery, whereas lipocalin- 2 and thrombospondin-1 remained elevated. ConclusionsChronic endogenous PTH excess is not sufficient to induce a detectable thermogenic or energy- dissipating adipose program in humans under basal clinical conditions. These findings challenge direct extrapolation from rodent PTH/PTHrP models and reposition the human PTH-adipose axis as a selective secretory and remodeling pathway rather than a dominant driver of adipose browning or wasting. HighlightsO_LIPHPT provides an in vivo human model of chronic endogenous PTH excess. C_LIO_LIPTH/PTH1R associations with body composition are lost after stringent confounder control. C_LIO_LIParathyroidectomy normalizes mineral metabolism without inducing adipose browning or wasting. C_LIO_LISupraclavicular adipose histology, UCP1 staining, transcriptomics, and proteomics show no thermogenic activation. C_LIO_LIPHPT unmasks a selective adipose-related secretory signature with reversible and persistent components. C_LI