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Secondary Hyperparathyroidism Following Biliopancreatic Diversion

Secondary Hyperparathyroidism Following Biliopancreatic Diversion Abstract Objective: To investigate the cause of osteomalacia following biliopancreatic diversion (BPD) surgery for obesity. Design: A retrospective, case-comparison study. Setting: A tertiary care center. Patients: A case group of 12 subjects (including 9 women; mean age±SEM, 48.5±3.0 years; mean preoperative body mass index ±SEM, 43.7 ± 2.3 kg/m2; and mean weight loss±SEM, 75± 14 kg) who have undergone BPD (referred to as BPD group hereafter) and a comparison group of 10 subjects (including 9 women; mean age±SEM,49.6±3.3 years; mean preoperative body mass index ±SEM, 44.0 ± 2.5 kg/m2; and mean weight loss±SEM, 55±15 kg) following vertical banded gastroplasty (VBG) (referred to as VBG group hereafter). Main Outcome Measures: Serum and urine markers for bone metabolism. Results: Compared with the VBG group, the BPD group had significantly lower concentrations of the following components: serum calcium (2.14±0.05 mmol/L vs 2.37±0.05 mmol/L [8.6±0.2 mg/dL vs 9.5±0.2 mg/ dL]), serum 25-hydroxyvitamin D (24±6 nmol/L vs 64±6 nmol/L), urine calcium excretion (1.7±0.7 mmol/d vs 4.5±0.7 mmol/d [68±28 mg/d vs 180±28 mg/d]), and serum carotene (0.40±0.15 mmol/L vs 1.29±0.16 mmol/ L). The BPD group had significantly higher concentrations of the following components: serum parathyroid hormone (13.6±2.1 pmol/L vs 5.2±2.3 pmol/L), serum alkaline phosphatase (139±8 U/L vs 86 ± 9 U/L), and urinary hydroxyproline/creatinine (52±5 μmol/mmol vs 19±5 μmol/mmol). Conclusion: These data suggest that following BPD, secondary hyperparathyroidism attributed to hypocalcemia results from malabsorption of vitamin D. However, we cannot exclude the possibility of concurrent calcium malabsorption with vitamin D malabsorption.Arch Surg. 1996;113:1048-1052 References 1. Scopinaro N, Gianetta E, Civalleri D, Bonalumi U, Friedman D, Bachi V. Partial and total biliopancreatic bypass in the surgical treatment of obesity . Int J Obes . 1981;5:421-429. 2. Nightengale ML, Sarr MG, Kelly KA, Jensen MD, Zinsmeister AR, Palumbo PJ. Prospective evaluation of the vertical banded gastroplasty as the primary operation for morbid obesity . Mayo Clin Proc . 1991;66:773-782.Crossref 3. Holian DK, Clare MW. Biliopancreatic bypass for morbid obesity: late results and complications . Clin Nutr . 1986;5:133-136. 4. Gianetta E, Friedman D, Adami GF, et al. Etiological factors of protein malnutrition after biliopancreatic diversion . Gastroenterol Clin North Am . 1987;16: 503-504. 5. Grimm IS, Schindler W, Haluszka O. Steatohepatitis and fatal hepatic failure after biliopancreatic diversion . Am J Gastoenterol . 1992;87:775-779. 6. Langdon DE, Leffingwell T, Rank D. Hepatic failure after biliopancreatic diversion . Am J Gastroenterol . 1993;88:321. 7. Compston JE, Vedi S, Gianetta E, Watson G, Civalleri D, Scopinaro N. Bone histomorphometry and vitamin D status after biliopancreatic bypass for obesity . Gastroenterology . 1984;87:350-356. 8. SAS Institute Inc, SAS/STAT User's Guide . 4th ed. Cary, NC: SAS Institute, Inc; 1990. 9. Atkinson RL, Dahms WT, Bray GA, Schwartz AA. Parathyroid hormone levels in obesity: effects of intestinal bypass surgery . Miner Electrolyte Metab . 1978; 1:315-320. 10. Liel Y, Ulmer E, Shary J, Hollis BW, Bell NH. Low circulating vitamin D in obesity . Calcif Tissue Int . 1988;43:199-201.Crossref 11. Bell NH, Epsteim S, Greene A, Shary J, Oexmann MJ, Shaw S. Evidence for alteration of the vitamin D-endocrine system in obese subjects . J Clin Invest . 1985;76:370-373.Crossref 12. Compston JE, Vedi S, Ledger JE, Webb A, Gazet J-C, Pilkington RE. Vitamin D status and bone histomorphometry in gross obesity . Am J Clin Nutr . 1981; 34:2359-2563. 13. Andersen T, McNair P, Fogh-Andersen N, Transbol I. Calcium homeostasis in morbid obesity . Miner Electrolyte Metab . 1984;10:316-318. 14. Katz BS, Jackson GJ, Hollis BW, Bell NH. Diagnostic criteria of vitamin D deficiency . Endocrinology . 1993:3:248-253.Crossref 15. Bell NH. Vitamin D-endocrine system . J Clin Invest . 1985;76:1-6.Crossref 16. Eddy RL. Metabolic bone disease after gastrectomy . Am J Med . 1971;50: 442-9.Crossref 17. Thompson GR, Neale G, Watts JM, Booth CC. Detection of vitamin-D deficiency after partial gastrectomy . Lancet . 1966;1:623-626.Crossref 18. Morgan DB, Paterson CR, Woods CG, Pulvertaft CN, Fourman P. Search for osteomalacia in 1228 patients after gastrectomy and other operations of the stomach . Lancet . 1965;2:1085-1088.Crossref 19. Clark CG, Crooks J, Dawson AA, Mitchell PEG. Disordered calcium metabolism after polya partial gastrectomy . Lancet . 1964;1:724-738. 20. Higgins PM, Pridie RB. Postgastrectomy osteomalacia: incidence after the noloop and other types of gastrectomy . Br J Surg . 1966;53:881-885.Crossref 21. Barger-Lux MJ, Heaney RP. Effects of calcium restriction on metabolic characteristics of pre-menopausal women . J Clin Endocrinol Metab . 1993;76:103-107. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Secondary Hyperparathyroidism Following Biliopancreatic Diversion

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1996.01430220042009
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To investigate the cause of osteomalacia following biliopancreatic diversion (BPD) surgery for obesity. Design: A retrospective, case-comparison study. Setting: A tertiary care center. Patients: A case group of 12 subjects (including 9 women; mean age±SEM, 48.5±3.0 years; mean preoperative body mass index ±SEM, 43.7 ± 2.3 kg/m2; and mean weight loss±SEM, 75± 14 kg) who have undergone BPD (referred to as BPD group hereafter) and a comparison group of 10 subjects (including 9 women; mean age±SEM,49.6±3.3 years; mean preoperative body mass index ±SEM, 44.0 ± 2.5 kg/m2; and mean weight loss±SEM, 55±15 kg) following vertical banded gastroplasty (VBG) (referred to as VBG group hereafter). Main Outcome Measures: Serum and urine markers for bone metabolism. Results: Compared with the VBG group, the BPD group had significantly lower concentrations of the following components: serum calcium (2.14±0.05 mmol/L vs 2.37±0.05 mmol/L [8.6±0.2 mg/dL vs 9.5±0.2 mg/ dL]), serum 25-hydroxyvitamin D (24±6 nmol/L vs 64±6 nmol/L), urine calcium excretion (1.7±0.7 mmol/d vs 4.5±0.7 mmol/d [68±28 mg/d vs 180±28 mg/d]), and serum carotene (0.40±0.15 mmol/L vs 1.29±0.16 mmol/ L). The BPD group had significantly higher concentrations of the following components: serum parathyroid hormone (13.6±2.1 pmol/L vs 5.2±2.3 pmol/L), serum alkaline phosphatase (139±8 U/L vs 86 ± 9 U/L), and urinary hydroxyproline/creatinine (52±5 μmol/mmol vs 19±5 μmol/mmol). Conclusion: These data suggest that following BPD, secondary hyperparathyroidism attributed to hypocalcemia results from malabsorption of vitamin D. However, we cannot exclude the possibility of concurrent calcium malabsorption with vitamin D malabsorption.Arch Surg. 1996;113:1048-1052 References 1. Scopinaro N, Gianetta E, Civalleri D, Bonalumi U, Friedman D, Bachi V. Partial and total biliopancreatic bypass in the surgical treatment of obesity . Int J Obes . 1981;5:421-429. 2. Nightengale ML, Sarr MG, Kelly KA, Jensen MD, Zinsmeister AR, Palumbo PJ. Prospective evaluation of the vertical banded gastroplasty as the primary operation for morbid obesity . Mayo Clin Proc . 1991;66:773-782.Crossref 3. Holian DK, Clare MW. Biliopancreatic bypass for morbid obesity: late results and complications . Clin Nutr . 1986;5:133-136. 4. Gianetta E, Friedman D, Adami GF, et al. Etiological factors of protein malnutrition after biliopancreatic diversion . Gastroenterol Clin North Am . 1987;16: 503-504. 5. Grimm IS, Schindler W, Haluszka O. Steatohepatitis and fatal hepatic failure after biliopancreatic diversion . Am J Gastoenterol . 1992;87:775-779. 6. Langdon DE, Leffingwell T, Rank D. Hepatic failure after biliopancreatic diversion . Am J Gastroenterol . 1993;88:321. 7. Compston JE, Vedi S, Gianetta E, Watson G, Civalleri D, Scopinaro N. Bone histomorphometry and vitamin D status after biliopancreatic bypass for obesity . Gastroenterology . 1984;87:350-356. 8. SAS Institute Inc, SAS/STAT User's Guide . 4th ed. Cary, NC: SAS Institute, Inc; 1990. 9. Atkinson RL, Dahms WT, Bray GA, Schwartz AA. Parathyroid hormone levels in obesity: effects of intestinal bypass surgery . Miner Electrolyte Metab . 1978; 1:315-320. 10. Liel Y, Ulmer E, Shary J, Hollis BW, Bell NH. Low circulating vitamin D in obesity . Calcif Tissue Int . 1988;43:199-201.Crossref 11. Bell NH, Epsteim S, Greene A, Shary J, Oexmann MJ, Shaw S. Evidence for alteration of the vitamin D-endocrine system in obese subjects . J Clin Invest . 1985;76:370-373.Crossref 12. Compston JE, Vedi S, Ledger JE, Webb A, Gazet J-C, Pilkington RE. Vitamin D status and bone histomorphometry in gross obesity . Am J Clin Nutr . 1981; 34:2359-2563. 13. Andersen T, McNair P, Fogh-Andersen N, Transbol I. Calcium homeostasis in morbid obesity . Miner Electrolyte Metab . 1984;10:316-318. 14. Katz BS, Jackson GJ, Hollis BW, Bell NH. Diagnostic criteria of vitamin D deficiency . Endocrinology . 1993:3:248-253.Crossref 15. Bell NH. Vitamin D-endocrine system . J Clin Invest . 1985;76:1-6.Crossref 16. Eddy RL. Metabolic bone disease after gastrectomy . Am J Med . 1971;50: 442-9.Crossref 17. Thompson GR, Neale G, Watts JM, Booth CC. Detection of vitamin-D deficiency after partial gastrectomy . Lancet . 1966;1:623-626.Crossref 18. Morgan DB, Paterson CR, Woods CG, Pulvertaft CN, Fourman P. Search for osteomalacia in 1228 patients after gastrectomy and other operations of the stomach . Lancet . 1965;2:1085-1088.Crossref 19. Clark CG, Crooks J, Dawson AA, Mitchell PEG. Disordered calcium metabolism after polya partial gastrectomy . Lancet . 1964;1:724-738. 20. Higgins PM, Pridie RB. Postgastrectomy osteomalacia: incidence after the noloop and other types of gastrectomy . Br J Surg . 1966;53:881-885.Crossref 21. Barger-Lux MJ, Heaney RP. Effects of calcium restriction on metabolic characteristics of pre-menopausal women . J Clin Endocrinol Metab . 1993;76:103-107.

Journal

Archives of SurgeryAmerican Medical Association

Published: Oct 1, 1996

References