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  • Title: Secondary Hyperparathyroidism in Patients with Biliopancreatic Diversion After 10 Years of Follow-up, and Relationship with Vitamin D and Serum Calcium.
    Author: Alejo Ramos M, Cano Rodríguez IM, Urioste Fondo AM, Pintor de la Maza B, Barajas Galindo DE, Fernández Martínez P, González Herráez L, González de Francisco T, Ballesteros Pomar MD.
    Journal: Obes Surg; 2019 Mar; 29(3):999-1006. PubMed ID: 30523538.
    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.
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