Endocrine Abstracts

Introduction: Osteoporosis is a major health problem in our countries. Primary hyperparathyroidism and obesity surgery increase this risk of adverse events such as fractures. We report the case of a patient with mild asymptomatic hyperparathyroidism with low serum mild hypercalcemia non-osteoporotic who developed osteoporosis after obesity surgery improved by parathyroidectomy.

Case: This is a female 55-year-old patient with past history appendectomy, stripping, hyperparathyroidism (November 2013), hypertension, type 2 diabetes (HbA1c 6.1%), helicobacter pylori infection, depressive syndrome, and menopause. His treatment includes candesartan, metformin, lecardipine, sitagliptin. In his preoperative assessment of obesity surgery we note: weight 131 kg, 1.62 meter, BMI 49.9 kg/m², BP 176/109 mmHg. In laboratory 8/12/2014 Calcium 2.7 mM, calciuria 368 mg/l, PTH 100.7 pg/ml (N<72), low vitamin D at 25 ng/ml and normal creatininemia. In 2013, she had been evaluated for her hyperparathyroidism, the osteodensitometry (november) evidenced the absence of osteoporosis. Surveillance had been proposed. She had a sleeve gastrectomy on November 3, 2014, and a treatment with multivitamin including vitamin D, 1 gram of calcium postoperatively but also esomeprazole 40 mg/d I addition to other treatment. Blood calcium was still slightly increased after surgery. In July 2017, there was the appearance of osteoporosis on the spine (L1-L4), and osteopenia on the femur. It was decided the parathyroidectomy of right P3 on January 4, 2018, calcium and PTH were normalized and on January 5, 2019 we noted the disappearance of osteoporosis (same machine). Her weight was 91 kgs (BMI 34.7 kg/m²). This observation seems to demonstrate that the presence of a mild non-symptomatic primary hyperpararthyroidism can be significantly worsen after sleeve gastrectomy and may be improved after parathyroidectomy.

Conclusions: Patients with non-symptomatic hyperparathyroidism before obesity surgery should be monitored by bone densitometry after.