Rates of secondary hyperparathyroidism after bypass operation for super-morbid obesity: An overlooked phenomenon

White, Michael G.; Ward, Marc A.; Applewhite, Megan K.; Wong, Harry J.; Prachand, Vivek N.; Angelos, Peter; Kaplan, Edwin L.; Grogan, Raymon H.

doi:10.1016/j.surg.2016.08.046

Cited by 13 publications

(23 citation statements)

References 15 publications

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“…Of those patients, 42% demonstrated clinically symptomatic hyperparathyroidism [6]. These studies suggest overcompensation of a physiologically hyperactive parathyroid gland in malabsorptive bariatric interventions.…”

Section: Parathyroid Physiology In Bariatricsmentioning

confidence: 85%

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Hospital Readmissions for Hyperparathyroidism After Bariatric Surgery in the United States: A National Database Review

Qafiti

Lopez

Kichler

et al. 2020

Cureus

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Introduction: The incidence and significance of hyperparathyroidism in patients after bariatric surgery have been established to some degree; however, the impact it has on the national healthcare system has not. We sought to assess the risk of readmission and related comorbidities in this patient population. Methods: The Healthcare Cost and Utilization Project Nationwide Readmission Database was queried for all patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Multivariate logistic regression analysis was conducted to identify factors associated with readmission for hyperparathyroidism. Results: A total of 915,792 patients between 2010 and 2015 were queried; 43.2% had undergone SG and 56.8% had RYGB. A total of 589 patients were readmitted for hyperparathyroidism; 80.8% were female and 68% had a Charlson comorbidity index ≥ 2. Factors associated with readmission were as follows: age 45-64 years (odds ratio [OR] 1.42, p=0.001), Medicare (OR 3.01, p<0.001) or Medicaid (OR 2.61, p<0.001) insurance status, lower median household income, renal failure (OR 17.14, p<0.001), hypertension (OR 2.89, p<0.001), and deficiency anemia (OR 2.62, p<0.01). Conclusions: Parathyroid axis monitoring may provide benefits to predictably high-risk patients. Appropriate surveillance may decrease the impact of bariatric hyperparathyroidism readmission on the U.S. healthcare system.

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Section: Parathyroid Physiology In Bariatricsmentioning

confidence: 85%

“…Parathyroid hormone (PTH) has been shown to physiologically compensate, causing additional metabolic strain on the body. Ultimately, secondary hyperparathyroidism precipitates [5,6].…”

Section: Introductionmentioning

confidence: 99%

Hospital Readmissions for Hyperparathyroidism After Bariatric Surgery in the United States: A National Database Review

Qafiti

Lopez

Kichler

et al. 2020

Cureus

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“…Therefore, the use of these two compounds, either separately or in combination is a must. [ 31 , 65 , 81 , 104 , 120 , 154 , 156 ].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the use of calcium (1000 mg of calcium element at least) and vitamin D (880 IU of cholecalciferol) supplements is a standard postoperative recommendation (Flores et al, Liu et al, Level of Evidence 1++, grade of recommendation A) [ 44 , 45 , 81 ]. However, the current recommendations for calcium and vitamin D intake (1200–2000 mg/day of elemental calcium combined with 400–800 U of vitamin D, according to the European guideline [ 20 ]) seem to be insufficient for avoiding secondary hyperparathyroidism, so higher doses should be considered, especially after malabsorptive surgeries (Obinwanne et al, White et al, Wei et al, Level of Evidence 3, grade of recommendation D) [ 104 , 154 , 156 ]. In biliopancreatic diversion/Scopinaro surgeries the GARIN group recommends a higher intake of calcium (2000 mg/d) and especially a higher intake of vitamin D (2000 IU/d) (grade of recommendation D).…”

Section: Discussionmentioning

confidence: 99%

Recommendations Based on Evidence by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) for the Pre- and Postoperative Management of Patients Undergoing Obesity Surgery

et al. 2020

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In order to develop evidence-based recommendations and expert consensus for nutrition management of patients undergoing bariatric surgery and postoperative follow-up, we conducted a systematic literature search using PRISMA methodology plus critical appraisal following the SIGN and AGREE-II procedures. The results were discussed among all members of the GARIN group, and all members answered a Likert scale questionnaire to assess the degree of support for every recommendation. Patients undergoing bariatric surgery should be screened preoperatively for some micronutrient deficiencies and treated accordingly. A VLCD (Very Low-Calorie Diet) should be used for 4–8 weeks prior to surgery. Postoperatively, a liquid diet should be maintained for a month, followed by a semi-solid diet also for one month. Protein requirements (1–1.5 g/kg) should be estimated using adjusted weight. Systematic use of specific multivitamin supplements is encouraged. Calcium citrate and vitamin D supplements should be used at higher doses than are currently recommended. The use of proton-pump inhibitors should be individualised, and vitamin B12 and iron should be supplemented in case of deficit. All patients, especially pregnant women, teenagers, and elderly patients require a multidisciplinary approach and specialised follow-up. These recommendations and suggestions regarding nutrition management when undergoing bariatric surgery and postoperative follow-up have direct clinical applicability.

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“…The number of patients suffering from renal failure and secondary hyperparathyroidism has been increasing in recent years . Secondary hyperparathyroidism, which causes long‐term hypocalcaemia, can result in hyperglycaemia, blood‐fat metabolic disturbances, blood pressure dysregulation and ectopic soft tissue calcification at the joints, muscles, brain and blood vessels.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Pharmacokinetics of dexmedetomidine administered to patients with end-stage renal failure and secondary hyperparathyroidism undergoing general anaesthesia

Zhong

Zhang

et al. 2017

J Clin Pharm Ther

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Rates of secondary hyperparathyroidism after bypass operation for super-morbid obesity: An overlooked phenomenon

Cited by 13 publications

References 15 publications

Hospital Readmissions for Hyperparathyroidism After Bariatric Surgery in the United States: A National Database Review

Hospital Readmissions for Hyperparathyroidism After Bariatric Surgery in the United States: A National Database Review

Recommendations Based on Evidence by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) for the Pre- and Postoperative Management of Patients Undergoing Obesity Surgery

Pharmacokinetics of dexmedetomidine administered to patients with end-stage renal failure and secondary hyperparathyroidism undergoing general anaesthesia

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