The significance of elevated levels of parathyroid hormone in patients with morbid obesity before and after bariatric surgery | Bariatric Surgery | JAMA Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Avioli  LV Intestinal absorption of calcium.  Arch intern med. 1972;129345- 355PubMedGoogle ScholarCrossref
Chapin  BLHomer  JKnodel  DHCarter  PL Secondary hyperparathyroidism following biliopancreatic diversion.  Arch surg. 1996;1311048- 1052PubMedGoogle ScholarCrossref
Compston  JEVedi  SGianetta  EWatson  GCivalleri  DScopinaro  N Bone histomorphometry and vitamin d status after biliopancreatic bypass for obesity.  Gastroenterology. 1984;87350- 356PubMedGoogle Scholar
Marceau  PBiron  SLebel  S  et al.  Does bone change after biliopancreatic diversion?  J gastrointest surg. 2002;6690- 698PubMedGoogle ScholarCrossref
Andersen  TMcnair  PHyldstrup  L  et al.  Secondary hyperparathyroidism of morbid obesity regresses during weight reduction.  Metabolism. 1988;37425- 428PubMedGoogle ScholarCrossref
Bell  NH Vitamin d-endocrine system.  J clin invest. 1985;761- 6PubMedGoogle ScholarCrossref
Bell  NHEpstein  SGreene  A  et al.  Evidence for alteration of the vitamin d-endocrine system in obese subjects.  J clin invest. 1985;76370- 373PubMedGoogle ScholarCrossref
Feng  JJGagner  M Laparoscopic biliopancreatic diversion with duodenal switch.  Semin laparosc surg. 2002;9125- 129PubMedGoogle ScholarCrossref
Baltasar  ABou  RMiro  JBengochea  MSerra  CPerez  N Laparoscopic biliopancreatic diversion with duodenal switch: technique and initial experience.  Obes surg. 2002;12245- 248PubMedGoogle ScholarCrossref
August 2003

The significance of elevated levels of parathyroid hormone in patients with morbid obesity before and after bariatric surgery

Author Affiliations

From the Department of Surgery, University of Southern California, Los Angeles.

Arch Surg. 2003;138(8):891-897. doi:10.1001/archsurg.138.8.891

Hypothesis  The risk of hyperparathyroidism after the duodenal switch operation is related to the length of the common channel.

Design  A retrospective analysis of patients following the duodenal switch operation from october 2, 2000, through february 1, 2002.

Setting  Academic tertiary referral hospital.

Patients  One hundred sixty-five consecutive patients underwent the duodenal switch operation, performed for morbid obesity, with common channel lengths of 75 cm (n = 103 [group a]) and 100 cm (n = 62 [group b]).

Main outcome measures  Weight loss and parathyroid hormone, corrected calcium, and 25-hydroxyvitamin d (25-oh d) levels were compared between groups a and b. values were determined preoperatively, early postoperatively (3-6 months), and late postoperatively (9-18 months).

Results  Both groups exhibited a slight reduction in serum calcium concentration, with one quarter decreasing below the normal range. hyperparathyroidism was more common in group a than group b preoperatively (38.9% vs 14.9%), reflecting the higher body mass index of patients in group a. hyperparathyroidism was also more frequent in the early (54.9% vs 30.9%) and late (49.4% vs 20.5%) postoperative periods in group a vs group b. new-onset hyperparathyroidism was also more common in group a than group b (42.0% vs 13.3%). after 1 year, subnormal 25-oh d levels were found in 17.0% of the patients in group a and in 10.0% of the patients in group b. median 25-oh d levels increased in both groups, but tended to be higher in group b.

Conclusions  Patients with shorter common channels had a higher risk of developing hyperparathyroidism. this may be related to limited 25-oh d absorption.