title: Severe obesity is associated with symptomatic presentation, higher parathyroid hormone levels, and increased gland weight in primary hyperparathyroidism.
abstract: BACKGROUND
  A relationship between primary hyperparathyroidism (PHPT) and obesity has been observed but is incompletely understood. Furthermore, obesity has been associated with vitamin D deficiency, suggesting that the three conditions may be linked.
  
  
  OBJECTIVE
  We hypothesized that PHPT in morbidly obese patients is more severe and that the difference may be explained by vitamin D deficiency. DESIGN AND SETTING, PARTICIPANTS, AND OUTCOME MEASURES: Records of 196 patients with surgically treated PHPT and known body mass index (BMI) were examined. Patients were stratified into three BMI groups: group I (nonobese), BMI < 25 kg/m(2) (n = 54); group II (non-severely obese), BMI 25-34 kg/m(2) (n = 102); and group III (severely obese), BMI 35 kg/m(2) or greater (n = 40).
  
  
  RESULTS
  Preoperative PTH levels were higher in group ΙΙΙ compared with group Ι (181 ± 153 vs. 140 ± 80 pg/ml, p = 0.04). Group III patients had larger tumors on average compared with group I (1.8 ± 1.5 vs. 1.04 ± 1.5 g, P = 0.0002). In group III, BMI positively correlated with parathyroid tumor weight (r = 0.5, P = 0.002). Postoperative PTH was higher in group III compared with group Ι (61 ± 41 vs. 44 ± 28 pg/ml, P = 0.02). There was higher frequency of depression, musculoskeletal symptoms, weakness, and gastroesophageal reflux disease in group III patients.
  
  
  CONCLUSIONS
  BMI positively correlated with parathyroid tumor weight independent of vitamin D. Severely obese patients have larger parathyroid tumor weight, higher pre- and postoperative PTH, and greater symptoms.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Mohamed Abdelgadir
authors.initials: MA
authors.lastname: Adam
authors.forename: Brian R
authors.initials: BR
authors.lastname: Untch
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Danko
authors.forename: Sandra
authors.initials: S
authors.lastname: Stinnett
authors.forename: Darshana
authors.initials: D
authors.lastname: Dixit
authors.forename: James
authors.initials: J
authors.lastname: Koh
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Marks
authors.forename: John A
authors.initials: JA
authors.lastname: Olson
mesh_terms: D000704:Analysis of Variance; D015992:Body Mass Index; D016009:Chi-Square Distribution; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000150:complications* / Q000473:pathology / Q000601:surgery; D008499:Medical Records; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000473:pathology; D010280:Parathyroid Glands / Q000473:pathology* / Q000601:surgery; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000150:complications* / Q000473:pathology / Q000601:surgery; D012720:Severity of Illness Index; D014807:Vitamin D / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications / Q000473:pathology
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D