Does Bariatric Surgery Increase the Formation of Parathyroid Adenoma

Abstract

Background: Bariatric surgery is an important treatment option of obesity over the last decade. While bariatric surgery reduces weight and helps maintanence, it significantly reduces the obesity-related comorbidities, as well. Secondary hyperparathyroidism is a common metabolic complication of bariatric surgery, despite the recommended dose of calcium and vitamin D replacement. We have presented in our article that one of the results of bariatric surgery may be parathyroid adenoma (PA), although the long-term results are unknown. Methods: A total of 838 patients who had undergone sleeve gastrectomy (SG) between 2015 and 2018 were screened retrospectively. We analyzed the data of five patients with parathyroidectomy with PA and indicative of operation according to international guideline. Parathormone (PTH), 25-OH vitamin D3 (25OHD), calcium, phosphate (P), albümin, and alkaline phosphatase were evaluated, which were measured before and after parathyroidectomy. Weight changes of patients before and after bariatric surgery were calculated. Results: Mean age of the 838 patients were 38.7 -10.4 (years) with SG. Six hundred and eighty three subjects (81.5%) were women and 155 (18.5%) were men. Mean body weight changed before and after SG was respectively, 45.04 -6.37 kg/m 2 , 35.80 -7.6937 kg/m 2 , ( p = 0.002). All patients with PA were female and the mean age was 41.4 -9.0 (years). The mean time from bariatric surgery to parathyroid surgery was 2 -1 years. In 838 cases, PA was detected in five cases and the prevalence was found to be 0.6%. Conclusion: Long-term hypocalcemia may cause development of PA as a result of parathyroid gland stimulation. Clarification of increased PTH secondary to hypocalcemia, intestinal adaptation mechanisms, local effect of the wnt signaling pathway, change in carrier proteins, and the effect of adipokines on multifactorial conditions are extremely important to prevent bone loss in patients who underwent bariatric surgery. Development of PA after bariatric surgery is a serious complication and should not be overlooked. Therefore, long-term and strict follow-up is very important after surgery.

Bone Response to Weight Loss Following Bariatric Surgery

“…The mechanism resides in calcium malabsorption which, in association with vitamin D deficiency, promotes secondary hyperparathyroidism leading to bone resorption. There are even claims that, in the very long term, post-bariatric surgery hypocalcemia may overstimulate parathyroid gland and lead to the anectodical development of a parathyroid adenoma ( 40 ). Further, intestinal adaptation mechanisms, local effect of the Wnt/β-catenin signaling pathway, changes in carrier proteins, and the effect of adipokines are other calcium-related mechanisms potentially involved in bone loss after bariatric surgery ( 40 , 41 ).…”

Hypocalcemia after parathyroidectomy in patients with a history of bariatric surgery

“…While bariatric procedures are well known to be associated with secondary hyperparathyroidism [24][25][26][27], recent studies suggest that bariatric surgery may also raise the risk of developing primary hyperparathyroidism (PHP) and the formation of parathyroid adenomas [9][10][11][12][13][14]. Keskin et al reported ve cases of PHP in patients who underwent prior SG, and suggested that there may be a relationship between bariatric surgery and PHP [13]. In the present study, 1.5% of patients in our cohort with PHP who underwent parathyroidectomy had a history of bariatric surgery, which is evidence that this is a clinically relevant population.…”

“…The number of bariatric operations being performed is increasing [8]. There are reports of patients who are post-bariatric surgery going on to develop endocrine abnormalities of the thyroid and parathyroid glands, including primary hyperparathyroidism (PHP) [9][10][11][12][13][14]. Although there is a growing body of literature supporting that patients with a history of bariatric surgery who undergo subsequent thyroidectomy are at increased risk for hypocalcemia [15,16], hypocalcemia after parathyroidectomy is not well-studied.…”

The Eucalcemic Patient With Elevated Parathyroid Hormone Levels

“…Interestingly, there have been reports of PHPT with hypercalcemia after RYBG [ 42 ]. These cases may represent classical PHPT in a patient with RYGB or tertiary hyperparathyroidism in patients with prolonged PTH stimulation somewhat akin to kidney disease [ 43 ].…”