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

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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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Acknowledgments

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

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Authors and Affiliations

  1. Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Altos de Nava s/n, Edificio Administrativo Ala Sur, 2ª planta, 24008, León, Spain

    Mirian Alejo Ramos, Isidoro M. Cano Rodríguez, Ana M. Urioste Fondo, Begoña Pintor de la Maza, David E. Barajas Galindo, Paula Fernández Martínez & María D. Ballesteros Pomar

  2. Department of General Surgery, Complejo Asistencial Universitario de León, Altos de Nava s/n, Edificio Administrativo Ala Sur, 2ª planta, 24008, León, Spain

    Luis González Herráez & Tomás González de Francisco

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  1. Mirian Alejo Ramos
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Correspondence to Mirian Alejo Ramos.

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Alejo Ramos, M., Cano Rodríguez, I.M., Urioste Fondo, A.M. et al. Secondary Hyperparathyroidism in Patients with Biliopancreatic Diversion After 10 Years of Follow-up, and Relationship with Vitamin D and Serum Calcium. OBES SURG 29, 999–1006 (2019). https://doi.org/10.1007/s11695-018-03624-3

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