Faculty Collaboration Database

Association between body mass index and multigland primary hyperparathyroidism. J Surg Res 2016 May 01;202(1):132-8

Date

04/17/2016

Pubmed ID

27083959

DOI

10.1016/j.jss.2015.12.055

Scopus ID

2-s2.0-84960942006 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

INTRODUCTION: Multigland disease (MGD) accounts for 15% of sporadic primary hyperparathyroidism (pHPT). Several studies have reported a link between obesity and calcium metabolism (e.g., increased incidence of pHPT, higher levels of parathyroid hormone, lower vitamin D levels, and larger parathyroid glands). Obese patients have also been shown to require reoperation for persistent/recurrent pHPT more often than nonobese controls. We hypothesize that obese patients may have a higher prevalence of MGD.

METHODS: This was a retrospective review of a prospectively collected parathyroid database that included adult patients with sporadic pHPT, who underwent initial parathyroidectomy between 1999 and 2013. Demographic, clinicopathologic, operative, and laboratory data were assessed for associations with MGD.

RESULTS: Of 1305 consecutive patients, 200 (15%) had MGD. Median age was 59 y. Univariate analyses demonstrated that MGD was associated with age > 60 y, higher body mass index (BMI), history of lithium therapy, lower 24-h urine calcium excretion, higher serum alkaline phosphatase levels, and smaller size of the first excised parathyroid gland. On multivariate analyses, predictors of MGD were BMI 30-39.9 kg/m(2) (odds ratio [OR] 1.5; 95% confidence interval [CI] 1.2-2.5), BMI ≥ 40 kg/m(2) (OR 1.8; 95% CI 1.3-3.1), and smaller size of the first excised parathyroid (OR 0.7; 95% CI 0.6-0.8).

CONCLUSIONS: This study demonstrates a higher incidence of MGD in obese and morbidly obese patients. Due to a higher risk of MGD, surgeons should have a lower threshold to perform bilateral exploration in obese patients, especially if the first excised parathyroid gland is relatively small.

Author List

Glenn JA, Yen TW, Javorsky BR, Rose BG, Carr AA, Doffek KM, Evans DB, Wang TS

Authors

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Bradley R. Javorsky MD Associate Professor in the Medicine department at Medical College of Wisconsin
Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Body Mass Index
Female
Follow-Up Studies
Humans
Hyperparathyroidism, Primary
Incidence
Logistic Models
Male
Middle Aged
Obesity
Parathyroidectomy
Retrospective Studies
Risk Factors