Introduction: Bariatric surgery provides an effective option for the management of morbid obesity. Several studies have investigated the association between bariatric surgery and secondary hyperparathyroidism (SHPT). This study aims to compare the levels of blood biomarkers, specifically, calcium (Ca), vitamin D, and phosphate (PO4), and their association with parathyroid hormone (PTH) levels pre- and post-bariatric surgery. In addition, it aims to assess the prevalence of hyperparathyroidism post-bariatric surgery in a tertiary care hospital in Saudi Arabia.
Material and Methods: A prospective cohort study was conducted at a large tertiary care hospital between May 2017 and April 2019. The study included adult obese patients who underwent laparoscopic sleeve gastrectomy (LSG). Patients were excluded if they were known to have any comorbidities, receiving vitamin supplements, and those who had undergone bariatric procedures previously. Routine blood tests, including PTH, vitamin D, Ca, and PO4, were collected at baseline, and post-surgery.
Results: A total of 143 patients who underwent LSG were included in the study. Hyperparathyroidism was observed in 15.4% of patients at baseline and in 36.4% of patients’ post-surgery (p < 0.001). Low vitamin D levels, which were highly prevalent before surgery, decreased sustainably (66.4% pre-operative and 28% at follow-up after surgery, P=0.032). Baseline hypocalcemia was observed in 20.3% of patients compared to 8.4% post-surgery (P=0.546). Hypophosphatemia was present in 60.8% of subjects at baseline, while the percentage dropped to 21.7% post-surgery. There was a significant association between PO4 and PTH levels at baseline. Post-operatively, there was a significant correlation between PTH and both vitamin D and calcium levels.
Conclusion: Our study showed that the higher levels of PTH post LSG can be related to vitamin D deficiency and lower calcium levels, despite patients following the provided recommendations for supplementation. This study also emphasizes the importance of routine testing for hyperparathyroidism both before and after bariatric surgery.

Keywords: bariatric surgery, morbid obesity, hyperparathyroidism, calcium, vitamin D


中文翻译：

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袖状胃切除术后肥胖患者继发性甲状旁腺功能亢进

简介：减肥手术为治疗病态肥胖提供了一种有效的选择。多项研究调查了减肥手术与继发性甲状旁腺功能亢进症 (SHPT) 之间的关系。本研究旨在比较血液生物标志物的水平，特别是钙 (Ca)、维生素 D 和磷酸盐 (PO4) 的水平，以及它们与减肥手术前后的甲状旁腺激素 (PTH) 水平的关系。此外，它旨在评估沙特阿拉伯一家三级医院的减肥手术后甲状旁腺功能亢进症的患病率。
材料与方法：2017 年 5 月至 2019 年 4 月在一家大型三级医院进行了一项前瞻性队列研究。该研究包括接受腹腔镜袖状胃切除术 (LSG) 的成年肥胖患者。如果患者已知有任何合并症，接受维生素补充剂，以及之前接受过减肥手术的患者，则被排除在外。在基线和手术后收集常规血液测试，包括 PTH、维生素 D、Ca 和 PO4。
结果：共有 143 名接受 LSG 的患者被纳入研究。基线时 15.4% 的患者和术后 36.4% 的患者观察到甲状旁腺功能亢进（p < 0.001）。术前普遍存在的低维生素 D 水平持续下降（术前 66.4%，术后随访 28%，P=0.032）。在 20.3% 的患者中观察到基线低钙血症，而术后为 8.4% (P=0.546)。基线时 60.8% 的受试者出现低磷血症，而手术后该百分比降至 21.7%。基线时 PO4 和 PTH 水平之间存在显着关联。术后，PTH 与维生素 D 和钙水平之间存在显着相关性。
结论：我们的研究表明，尽管患者遵循了提供的补充建议，但 LSG 后 PTH 水平升高可能与维生素 D 缺乏和钙水平降低有关。这项研究还强调了减肥手术前后对甲状旁腺功能亢进进行常规检测的重要性。

关键词：减肥手术，病态肥胖，甲状旁腺功能亢进，钙，维生素D