Role of calcium malabsorption in the development of secondary hyperparathyroidism after biliopancreatic diversion.
Secondary hyperparathyroidism (SH) is a frequent metabolic complication of bariatric surgery. Around 70%of patients who undergo biliopancreatic diversion (BPD) have this complication in the long term. The aim of this study was to evaluate the relative influence of vitamin D deficiency and calcium malabsorption in the development of SH in patients who underwent BPD. We reviewed the mean values of PTH throughout the post-operative follow-up and of related biochemical data (25-hydroxyvitamin D, calcium, magnesium) of 121 patients who underwent BPD at our institute from November 1996 to November 2004 (mean follow-up 66 months). Mean PTH correlated negatively with mean 25-hydroxyvitamin D (r=-0.27, p=0.003) and with urinary calcium(r=-0.19, p=0.047), and positively with age (r=0.22, p=0.018). However, a high mean PTH was found in 48.7% patients with mean 25-hydroxyvitamin D >or=30 ng/ml and in 80.0% patients with mean 25-hydroxyvitamin D between 20 and 30 ng/ml. The mean PTH was normal in 5 patients without calcium supplements at present, and progressively increased in parallel to the calcium dose in the rest of patients, although mean 25-hydroxyvitamin D levels were not related to the calcium dose. Our data suggest that individual differences in active and/or passive calcium absorption determine intractable SH after BPD in around half of the patients who have normal levels of 25-hydroxyvitamin D and in 80% of patients with 25-hydroxyvitamin D levels between 20 and 30 ng/ml after BPD, worsening with age.
Balsa
J A
JA
Department of Endocrinology and Clinical Nutrition, Ramón y Cajal Hospital, Madrid, Spain. jbalsa.hrc@salud.madrid.org
Botella-Carretero
J I
JI
Peromingo
R
R
Zamarrón
I
I
Arrieta
F
F
Muñoz-Malo
T
T
Vázquez
C
C
D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000009:adverse effects; D015904:Biliopancreatic Diversion / Q000009:adverse effects*; D002118:Calcium / Q000378:metabolism* / Q000652:urine; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology*; D008274:Magnesium / Q000097:blood; D008286:Malabsorption Syndromes / Q000150:complications*; D008297:Male; D008593:Menopause; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D010281:Parathyroid Hormone / Q000378:metabolism; D012737:Sex Factors; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications*
D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D008274:Magnesium; D002118:Calcium