Background <p>Poly (ADP-ribose) polymerase inhibitors (PARPi) serve as crucial therapeutic agents in solid tumor treatment. Preclinical investigations suggest a potential protective function of PARPi against endocrine and metabolic impairments. Nevertheless, the existing body of evidence remains inconclusive on this aspect.</p> Purpose <p>Our aim was to evaluate the potential impact of PARPi on endocrine and metabolic disruptions in clinical trials.</p> Data sources <p>We conducted a comprehensive search across the Medline, EMBASE, PubMed, and Web of Science databases, along with the ClinicalTrials.gov registry.</p> Study selection <p>Phase II/III randomized controlled trials (RCTs) investigating the effects of PARPi in metabolic and endocrine processes were selected for inclusion in patients with solid tumors.</p> Data extraction <p>The primary outcomes of interest encompassed metabolic and endocrine dysfunctions.</p> Data synthesis <p>A total of 26 trials (<i>n</i> = 9,590 patients) were included in our meta-analysis. Niraparib demonstrated an increased risk of any-grade hyperglycemia (OR = 2.15, 95% CI 1.28–3.62), with patients receiving PARPi for metastatic pancreatic cancer showing a higher susceptibility to any-grade hyperglycemia (OR = 1.78, 95% CI 1.04–3.04). Conversely, rucaparib exhibited a potential ameliorative effect on hyperglycemia (OR = 0.54, 95% CI 0.30–0.97). No statistically significant disparities were observed for other outcomes associated with PARPi utilization.</p> Limitations <p>Among these RCTs included, 50% were assessed as low qualities due to high risk of bias.</p> Conclusions <p>Our meta-analysis demonstrated that PARPi may exert adverse effects on endocrine and metabolic pathways. Close monitoring of hyperglycemia is recommended for patients undergoing niraparib therapy, especially those with pancreatic cancer.</p> Trial registration <p>This meta-Analysis was prospectively registered in the PROSPERO database with ID CRD42023457959.</p> Graphical Abstract <p></p>