Bauzon Justin, Jin Judy, Noureldine Salem, Wang Sarah Ziqi, Beck Tim, Romero-Velez Gustavo
Cleveland Clinic Foundation, Department of Endocrine Surgery, Cleveland, Ohio.
Section of Endocrine Surgery, Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
J Surg Res. 2025 Jan;305:349-355. doi: 10.1016/j.jss.2024.12.006. Epub 2024 Dec 28.
Primary hyperparathyroidism (PHPT) is more prevalent in populations with obesity. Obesity-related vitamin D deficiency may affect rates of multigland parathyroid disease, but this relationship is less clear. We aimed to assess the relationship between obesity and the rate of multigland disease in patients with PHPT.
Patients who underwent parathyroidectomy from 2015 to 2021 for sporadic PHPT at a tertiary center were retrospectively analyzed. The primary outcome was rates of single-gland versus four-gland parathyroid hyperplasia in relation to obesity. Secondary outcomes included analysis of serum biochemistries [parathyroid hormone (PTH), calcium, 25(OH) vitamin D (25OHD)] before and 6 mo postoperatively based on obesity classification: no obesity (body mass index [BMI] <30 kg/m), Class 1 (BMI 30-34.9 kg/m), Class 2 (BMI 35-39.9 kg/m), Class 3 (BMI ≥40 kg/m). Statistical analysis was performed using Chi-square, Mann-Whitney U, and Kruskal-Wallis tests where applicable.
Of 2634 patients who underwent parathyroidectomy, a total of 1173 had obesity. Obesity did not confer any differences in the proportion of four-gland versus single-gland hyperplasia (25 versus 26%, P = 0.79). Compared to patients without obesity, preoperative PTH levels were higher in patients with Class 2 [86 (interquartile range [IQR] 66-118) versus 95 (IQR 70-137) pg/mL, P = 0.001] and Class 3 [86 (IQR 66-118) versus 104 (76-150) pg/mL, P < 0.001] obesity. Conversely, 25OHD before surgery was lower across obesity subclasses [no obesity: 36.0 (25.3-49.3), Class 1: 32.5 (24.0-46.0), Class 2: 32.9 (22.0-44.6), Class 3: 31.7 (20.4-45.0) ng/mL, P < 0.001]. Postoperative PTH and 25OHD improved in all cohorts. No calcium-related differences were found among patients based on obesity classification.
Obesity is not associated with an increased rate of four-gland hyperplasia in patients with PHPT, and therefore should not alter surgical management. The levels of 25OHD in patients with obesity should be monitored for vitamin deficiency preoperatively and postoperatively.
原发性甲状旁腺功能亢进症（PHPT）在肥胖人群中更为普遍。与肥胖相关的维生素D缺乏可能会影响多腺体甲状旁腺疾病的发生率，但这种关系尚不清楚。我们旨在评估肥胖与PHPT患者多腺体疾病发生率之间的关系。
对2015年至2021年在一家三级中心因散发性PHPT接受甲状旁腺切除术的患者进行回顾性分析。主要结局是与肥胖相关的单腺体与四腺体甲状旁腺增生的发生率。次要结局包括根据肥胖分类对术前和术后6个月的血清生化指标[甲状旁腺激素（PTH）、钙、25（OH）维生素D（25OHD）]进行分析：无肥胖（体重指数[BMI]<30kg/m）、1级（BMI 30-34.9kg/m）、2级（BMI 35-39.9kg/m）、3级（BMI≥40kg/m）。在适用的情况下，使用卡方检验、曼-惠特尼U检验和克鲁斯卡尔-沃利斯检验进行统计分析。
在2634例行甲状旁腺切除术的患者中，共有1173例肥胖。肥胖在四腺体增生与单腺体增生的比例上没有差异（25%对26%，P=0.79）。与无肥胖患者相比，2级肥胖患者[86（四分位间距[IQR]66-118）对95（IQR 70-137）pg/mL，P=0.001]和3级肥胖患者[86（IQR 66-118）对104（76-150）pg/mL，P<0.001]术前PTH水平更高。相反，各肥胖亚组术前25OHD水平较低[无肥胖：36.0（25.3-49.3），1级：32.5（24.0-46.0），2级：32.9（22.0-44.6），3级：31.7（20.4-45.0）ng/mL，P<0.001]。所有队列术后PTH和25OHD均有所改善。根据肥胖分类，患者之间未发现钙相关差异。
肥胖与PHPT患者四腺体增生率增加无关，因此不应改变手术管理。应监测肥胖患者术前和术后的25OHD水平，以了解维生素缺乏情况。
