Advertisement

Secondary Hyperparathyroidism in Patients with Biliopancreatic Diversion After 10 Years of Follow-up, and Relationship with Vitamin D and Serum Calcium

  • Mirian Alejo Ramos
  • Isidoro M. Cano Rodríguez
  • Ana M. Urioste Fondo
  • Begoña Pintor de la Maza
  • David E. Barajas Galindo
  • Paula Fernández Martínez
  • Luis González Herráez
  • Tomás González de Francisco
  • María D. Ballesteros Pomar
Original Contribution
  • 5 Downloads

Abstract

Background

Secondary hyperparathyroidism (SHPT) is a matter of concern after biliopancreatic diversion (BPD). The aim of this study was to investigate the relationship between SHPT, 25(OH)D, and calcium after BPD.

Design

A retrospective analysis in obese patients after BPD performed between 1998 and 2016.

Methods

Patients with at least 1 year of follow-up were included. SHPT was considered when PTH > 65 pg/mL in the absence of an elevated corrected calcium. 25(OH)D (ng/mL) status was defined as: deficiency < 20, insufficiency 20–29.9, and sufficiency ≥ 30.

Results

In total, 321 patients were included (76.6% women), with mean age 43.0 (10.5) years. Median follow-up was 6.0 (IQR 3.0–9.0) years. Mean body mass index was 49.8 (7.0) kg/m2. SHPT increased to a maximum of 81.9% in the ninth year of follow-up (95% CI: 1.5–9.1). Two years after surgery, 33.9% of patients with 25(OH)D sufficiency had SHPT (p = 0.001). Corrected calcium levels were lower in patients with PTH > 65 pg/mL when compared with PTH < 65 pg/mL; 1 year: 8.96 vs 9.1 mg/dL and 5 years: 8.75 vs 9.12 mg/dL (p < 0.01). After surgery, patients with PTH > 65 pg/mL and 25(OH)D sufficiency had lower corrected calcium levels when compared with subjects with PTH and 25(OH)D in normal range. Two years: 9.0 vs 9.2 mg/dL (p < 0.05) and 4 years: 8.9 vs 9.2 mg/dL (p < 0.01).

Conclusions

Once 25(OH)D is sufficient, the increase in PTH persists associated with a decrease in serum corrected calcium. It is important to ensure a sufficient calcium intake in these patients in order to avoid SHPT and osteomalacia in the future.

Keywords

Bariatric surgery Biliopancreatic diversion Hyperparathyroidism Serum calcium Parathyroid hormone Vitamin D 

Notes

Acknowledgments

The authors thank the Clinical Analysis team of CAULE for their collaboration and for providing us with the analytical data.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Informed Consent

No informed consent was needed in this study.

References

  1. 1.
    Jensen MD, Ryan DH, Apovian CM, et al. 2013AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American college of cardiology/American heart association task force on practice guidelines and the obesity society. J Am Coll Cardiol. 2014;347(63):2985–3023.Google Scholar
  2. 2.
    Higa K, Himpens J, Welbourn R, Dixon J, Kinsman R. The IFSO Global Registry Third IFSO Global Registry Report The International Federation for the Surgery of Obesity and Metabolic Disorders Third IFSO Global Registry Report. 2017.Google Scholar
  3. 3.
    Aranceta Bartrina J, Pérez RC. Epidemiología de la obesidad mórbida. In: Rubio Herrera MA, Ballesteros-Pomar MD, Sánchez Pernaute A, Torres García AJ, editors. Manual de obesidad mórbida. 2nd. ed. Madrid: Editora Médica Panamericana; 2015. p. 3–12.Google Scholar
  4. 4.
    Williams SE, Cooper K, Richmond B, et al. Perioperative management of bariatric surgery patients: focus on metabolic bone disease. Cleve Clin J Med. 2008;75(5):333–4. 336, 338Google Scholar
  5. 5.
    Mingrone G, Bornstein S, Le Roux CW. Optimisation of follow-up after metabolic surgery. Lancet Diabetes Endocrinol. 2018;5(6): Suppl 17: S2213–8587):487–99.CrossRefGoogle Scholar
  6. 6.
    Riedt CS, Brolin RE, Sherrell RM, et al. True fractional calcium absorption is decreased after Roux-en-Y gastric bypass surgery. TL - 14. Obesity (Silver Spring). 2006;14(11):1940–8.Google Scholar
  7. 7.
    Tondapu P, Provost D, Adams-Huet B, et al. Comparison of the absorption of calcium carbonate and calcium citrate after roux-en-Y gastric bypass. Obes Surg. 2009;19(9):1256–61.Google Scholar
  8. 8.
    Newbury L, Dolan K, Hatzifotis M, et al. Calcium and vitamin D depletion and elevated parathyroid hormone following biliopancreatic diversion. Obes Surg. 2003;13(6):893–5.Google Scholar
  9. 9.
    Bloomberg RD, Fleishman A, Nalle JE, et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;15(2):145–54.Google Scholar
  10. 10.
    Hewitt S, Søvik TT, Aasheim ET, et al. Secondary hyperparathyroidism, vitamin D sufficiency, and serum calcium 5 years after gastric bypass and duodenal switch. Obes Surg. 2013;23(3):384–90.Google Scholar
  11. 11.
    Figge J, Jabor A, Kazda A, et al. Anion gap and hypoalbuminemia. Crit Care Med. 1998;26(11):1807–10.Google Scholar
  12. 12.
    Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited. J Clin Endocrinol Metab. 2012;97(4):1153–8.Google Scholar
  13. 13.
    Liu C, Wu D, Zhang J-F, et al. Changes in bone metabolism in morbidly obese patients after bariatric surgery: a meta-analysis. Obes Surg. 2016;26(1):91–7.Google Scholar
  14. 14.
    Hewitt S, Aasheim ET, Søvik TT, et al. Relationships of serum 25-hydroxyvitamin D, ionized calcium and parathyroid hormone after obesity surgery. Clin Endocrinol. 2018;88(3):37–9.Google Scholar
  15. 15.
    Tardio V, Blais J-P, Julien A-S, et al. Serum parathyroid hormone and 25-Hydroxyvitamin D concentrations before and after biliopancreatic diversion. Obes Surg. 2018;28(7):1886–94.Google Scholar
  16. 16.
    Yanoff LB, Parikh SJ, Spitalnik A, et al. The prevalence of hypovitaminosis D and secondary hyperparathyroidism in obese Black Americans. Clin Endocrinol. 2006;64(5):523–9.Google Scholar
  17. 17.
    Sinha N, Shieh A, Stein EM, et al. Increased PTH and 1.25(OH)(2)D levels associated with increased markers of bone turnover following bariatric surgery. Obesity (Silver Spring). 2011;19(12):2388–93.Google Scholar
  18. 18.
    Mechanick JI, Youdim A, Jones DB, Timothy Garvey W, Hurley DL, Molly McMahon M, et al. American Association of Clinical ndocrinologists; Obesity Society, American Society forMetabolic & Bariatric Surgery. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient - 2013 update: Cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society. Obesity (Silver Spring). 2013;21 Suppl 1:S1–27Google Scholar
  19. 19.
    Ybarra J, Sánchez-Hernández J, Gich I, et al. Unchanged hypovitaminosis D and secondary hyperparathyroidism in morbid obesity after bariatric surgery. Obes Surg. 2005;15(3):330–5.Google Scholar
  20. 20.
    Moreiro J, Ruiz O, Perez G, et al. Parathyroid hormone and bone marker levels in patients with morbid obesity before and after biliopancreatic diversion. Obes Surg. 2007;17(3):348–54.Google Scholar
  21. 21.
    Topart P, Becouarn G, Salle A. Five-year follow-up after biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis. 2011;7(2):199–205.CrossRefGoogle Scholar
  22. 22.
    Chapin BL, Lemar HJ, Knodel DH, et al. Secondary hyperparathyroidism following biliopancreatic diversion. Arch Surg. 1996;131:1048–52.Google Scholar
  23. 23.
    Ballesteros-Pomar MD, González de Francisco T, Urioste-Fondo A, et al. Biliopancreatic diversion for severe obesity: long-term effectiveness and nutritional complications. Obes Surg. 2016;26(1):38–44.Google Scholar
  24. 24.
    Signori C, Zalesin KC, Franklin B, et al. Effect of gastric bypass on vitamin d and secondary hyperparathyroidism. Obes Surg. 2010;20(7):949–52.Google Scholar
  25. 25.
    Youssef Y, Richards WO, Sekhar N, et al. Risk of secondary hyperparathyroidism after laparoscopic gastric bypass surgery in obese women. Surg Endosc. 2007;21(8):1393–6.Google Scholar
  26. 26.
    Ceriani V, Cetta F, Pinna F, et al. Abnormal calcium, 25(OH)vitamin D, and parathyroid hormone after biliopancreatic diversion; correction through elongation of the common tract and reduction of the gastric pouch. Surg Obes Relat Dis. 2016;12(4):805–14.Google Scholar
  27. 27.
    Pugnale N, Giusti V, Suter M, et al. Bone metabolism and risk of secondary hyperparathyroidism 12 months after gastric banding in obese pre-menopausal women. Int J Obes Relat Metab Disord. 2003;27(1):110–6.Google Scholar
  28. 28.
    Karefylakis C, Näslund I, Edholm D, et al. Vitamin D status 10 years after primary gastric bypass: gravely high prevalence of hypovitaminosis D and raised PTH levels. Obes Surg. 2014;24(3):343–8.Google Scholar
  29. 29.
    Tsiftsis DDA, Mylonas P, Mead N, et al. Bone mass decreases in morbidly obese women after long limb-biliopancreatic diversion and marked weight loss without secondary hyperparathyroidism. A physiological adaptation to weight loss? Obes Surg. 2009;19(11):1497–503.Google Scholar
  30. 30.
    Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25:1150–6.CrossRefGoogle Scholar
  31. 31.
    Schafer AL, Weaver CM, Black DM, et al. Intestinal calcium absorption decreases dramatically after gastric bypass surgery despite optimization of vitamin D status. J Bone Miner Res. 2015;30(8):1377–85.Google Scholar
  32. 32.
    Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric. Obesity (Silver Spring). 2009;17(Suppl 1):S1–70.Google Scholar
  33. 33.
    Sánchez-Pernaute A, Pérez Aguirre M, Talavera EP. Derivación biliopancréatica de Scopinaro. In: Rubio Herrera M, Ballesteros-Pomar MD, Sánchez A, Torres A, editors. Manual de obesidad mórbida. 2nd. ed. Madrid: Médica Panamericana; 2015. p. 221–30.Google Scholar
  34. 34.
    Ruiz-Tovar J, Oller I, Tomas A, et al. Midterm impact of sleeve gastrectomy, calibrated with a 50-Fr bougie, on weight loss, glucose homeostasis, lipid profiles, and comorbidities in morbidly obese patients. Am Surg. 2012;78(9):969–74.Google Scholar
  35. 35.
    Carlin AM, Rao DS, Yager KM, et al. Treatment of vitamin D depletion after Roux-en-Y gastric bypass: a randomized prospective clinical trial. Surg Obes Relat Dis. 2009;5(4):444–9.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Mirian Alejo Ramos
    • 1
  • Isidoro M. Cano Rodríguez
    • 1
  • Ana M. Urioste Fondo
    • 1
  • Begoña Pintor de la Maza
    • 1
  • David E. Barajas Galindo
    • 1
  • Paula Fernández Martínez
    • 1
  • Luis González Herráez
    • 2
  • Tomás González de Francisco
    • 2
  • María D. Ballesteros Pomar
    • 1
  1. 1.Department of Endocrinology and NutritionComplejo Asistencial Universitario de LeónLeónSpain
  2. 2.Department of General SurgeryComplejo Asistencial Universitario de LeónLeónSpain

Personalised recommendations