The impact of obesity on the presentation of primary hyperparathyroidism

Hien Tran, Jacob S. Grange, Beverley Adams-Huet, Fiemu E. Nwariaku, Jennifer L. Rabaglia, Stacey L. Woodruff, Shelby A. Holt, Naim M. Maalouf

Research output: Contribution to journalArticle

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Abstract

Context: Obesity has been associated with elevated serum PTH (sPTH) in the general population. Obesity may also alter the clinical presentation in patients with primary hyperparathyroidism (PHPT). Objectives: The objectives of the study were to compare the clinical presentation of obese (OB) vs nonobese (NO) PHPT patients and to assess the impact of obesity on the presentation of PHPT independent of serum calcium and PTH. Patients: Consecutive PHPT patients who underwent parathyroidectomy between 2003 and 2012 by a single surgical group participated in the study. Setting: The study was conducted at an academic medical center. Design: Cross-sectional review of records of preoperative demographic, historical, laboratory, and densitometry findings and intraoperative pathological findings were compared in OB vs NO patients. Main Outcome Measures: The prevalence of nephrolithiasis and osteoporosis was measured. Results: Two hundred forty-seven PHPT patients were included in this analysis. Fifty percent were OB and 79% were women. Mean body mass index was 25.3 ± 3.3 and 36.0 ± 5.2 kg/m2 in the NO and OB groups, respectively. Age, gender, and race distribution was similar between the two groups. Serum calcium was similar between the groups (11.0 ± 0.7 mg/dL in NOvs 11.1 ± 0.9 mg/dL in OB, P = .13), whereas sPTH was higher in OB (151 ± 70 vs 136 ± 69 pg/mL, P = .03). The OB group exhibited higher prevalence of hypercalciuria (urine calcium > 400 mg per 24 h) (41% vs 23% in NO, P = .01) and nephrolithiasis (36% vs 21% in NO, P = .03). Despite higher sPTH, OB patients showed higher bone mineral density and a lower rate of osteoporosis (21% vs 35%, P = .05). Differences in the prevalence of hypercalciuria and osteoporosis between the groups persisted after adjustment for age, race, estimated glomerular filtration rate, gender, sPTH, and calcium. Conclusions: In PHPT patients, obesity is a risk factor for hypercalciuria and nephrolithiasis and is protective against osteoporosis. The impact of parathyroidectomy on the clinical features of obese PHPT patients merits further evaluation.

Original languageEnglish (US)
Pages (from-to)2359-2364
Number of pages6
JournalJournal of Clinical Endocrinology and Metabolism
Volume99
Issue number7
DOIs
StatePublished - 2014

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Primary Hyperparathyroidism
Obesity
Calcium
Hypercalciuria
Nephrolithiasis
Osteoporosis
Serum
Parathyroidectomy
Minerals
Bone
Densitometry
Glomerular Filtration Rate
Bone Density
Body Mass Index
Demography
Outcome Assessment (Health Care)
Urine

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

The impact of obesity on the presentation of primary hyperparathyroidism. / Tran, Hien; Grange, Jacob S.; Adams-Huet, Beverley; Nwariaku, Fiemu E.; Rabaglia, Jennifer L.; Woodruff, Stacey L.; Holt, Shelby A.; Maalouf, Naim M.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 99, No. 7, 2014, p. 2359-2364.

Research output: Contribution to journalArticle

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title = "The impact of obesity on the presentation of primary hyperparathyroidism",
abstract = "Context: Obesity has been associated with elevated serum PTH (sPTH) in the general population. Obesity may also alter the clinical presentation in patients with primary hyperparathyroidism (PHPT). Objectives: The objectives of the study were to compare the clinical presentation of obese (OB) vs nonobese (NO) PHPT patients and to assess the impact of obesity on the presentation of PHPT independent of serum calcium and PTH. Patients: Consecutive PHPT patients who underwent parathyroidectomy between 2003 and 2012 by a single surgical group participated in the study. Setting: The study was conducted at an academic medical center. Design: Cross-sectional review of records of preoperative demographic, historical, laboratory, and densitometry findings and intraoperative pathological findings were compared in OB vs NO patients. Main Outcome Measures: The prevalence of nephrolithiasis and osteoporosis was measured. Results: Two hundred forty-seven PHPT patients were included in this analysis. Fifty percent were OB and 79{\%} were women. Mean body mass index was 25.3 ± 3.3 and 36.0 ± 5.2 kg/m2 in the NO and OB groups, respectively. Age, gender, and race distribution was similar between the two groups. Serum calcium was similar between the groups (11.0 ± 0.7 mg/dL in NOvs 11.1 ± 0.9 mg/dL in OB, P = .13), whereas sPTH was higher in OB (151 ± 70 vs 136 ± 69 pg/mL, P = .03). The OB group exhibited higher prevalence of hypercalciuria (urine calcium > 400 mg per 24 h) (41{\%} vs 23{\%} in NO, P = .01) and nephrolithiasis (36{\%} vs 21{\%} in NO, P = .03). Despite higher sPTH, OB patients showed higher bone mineral density and a lower rate of osteoporosis (21{\%} vs 35{\%}, P = .05). Differences in the prevalence of hypercalciuria and osteoporosis between the groups persisted after adjustment for age, race, estimated glomerular filtration rate, gender, sPTH, and calcium. Conclusions: In PHPT patients, obesity is a risk factor for hypercalciuria and nephrolithiasis and is protective against osteoporosis. The impact of parathyroidectomy on the clinical features of obese PHPT patients merits further evaluation.",
author = "Hien Tran and Grange, {Jacob S.} and Beverley Adams-Huet and Nwariaku, {Fiemu E.} and Rabaglia, {Jennifer L.} and Woodruff, {Stacey L.} and Holt, {Shelby A.} and Maalouf, {Naim M.}",
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AU - Tran, Hien

AU - Grange, Jacob S.

AU - Adams-Huet, Beverley

AU - Nwariaku, Fiemu E.

AU - Rabaglia, Jennifer L.

AU - Woodruff, Stacey L.

AU - Holt, Shelby A.

AU - Maalouf, Naim M.

PY - 2014

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N2 - Context: Obesity has been associated with elevated serum PTH (sPTH) in the general population. Obesity may also alter the clinical presentation in patients with primary hyperparathyroidism (PHPT). Objectives: The objectives of the study were to compare the clinical presentation of obese (OB) vs nonobese (NO) PHPT patients and to assess the impact of obesity on the presentation of PHPT independent of serum calcium and PTH. Patients: Consecutive PHPT patients who underwent parathyroidectomy between 2003 and 2012 by a single surgical group participated in the study. Setting: The study was conducted at an academic medical center. Design: Cross-sectional review of records of preoperative demographic, historical, laboratory, and densitometry findings and intraoperative pathological findings were compared in OB vs NO patients. Main Outcome Measures: The prevalence of nephrolithiasis and osteoporosis was measured. Results: Two hundred forty-seven PHPT patients were included in this analysis. Fifty percent were OB and 79% were women. Mean body mass index was 25.3 ± 3.3 and 36.0 ± 5.2 kg/m2 in the NO and OB groups, respectively. Age, gender, and race distribution was similar between the two groups. Serum calcium was similar between the groups (11.0 ± 0.7 mg/dL in NOvs 11.1 ± 0.9 mg/dL in OB, P = .13), whereas sPTH was higher in OB (151 ± 70 vs 136 ± 69 pg/mL, P = .03). The OB group exhibited higher prevalence of hypercalciuria (urine calcium > 400 mg per 24 h) (41% vs 23% in NO, P = .01) and nephrolithiasis (36% vs 21% in NO, P = .03). Despite higher sPTH, OB patients showed higher bone mineral density and a lower rate of osteoporosis (21% vs 35%, P = .05). Differences in the prevalence of hypercalciuria and osteoporosis between the groups persisted after adjustment for age, race, estimated glomerular filtration rate, gender, sPTH, and calcium. Conclusions: In PHPT patients, obesity is a risk factor for hypercalciuria and nephrolithiasis and is protective against osteoporosis. The impact of parathyroidectomy on the clinical features of obese PHPT patients merits further evaluation.

AB - Context: Obesity has been associated with elevated serum PTH (sPTH) in the general population. Obesity may also alter the clinical presentation in patients with primary hyperparathyroidism (PHPT). Objectives: The objectives of the study were to compare the clinical presentation of obese (OB) vs nonobese (NO) PHPT patients and to assess the impact of obesity on the presentation of PHPT independent of serum calcium and PTH. Patients: Consecutive PHPT patients who underwent parathyroidectomy between 2003 and 2012 by a single surgical group participated in the study. Setting: The study was conducted at an academic medical center. Design: Cross-sectional review of records of preoperative demographic, historical, laboratory, and densitometry findings and intraoperative pathological findings were compared in OB vs NO patients. Main Outcome Measures: The prevalence of nephrolithiasis and osteoporosis was measured. Results: Two hundred forty-seven PHPT patients were included in this analysis. Fifty percent were OB and 79% were women. Mean body mass index was 25.3 ± 3.3 and 36.0 ± 5.2 kg/m2 in the NO and OB groups, respectively. Age, gender, and race distribution was similar between the two groups. Serum calcium was similar between the groups (11.0 ± 0.7 mg/dL in NOvs 11.1 ± 0.9 mg/dL in OB, P = .13), whereas sPTH was higher in OB (151 ± 70 vs 136 ± 69 pg/mL, P = .03). The OB group exhibited higher prevalence of hypercalciuria (urine calcium > 400 mg per 24 h) (41% vs 23% in NO, P = .01) and nephrolithiasis (36% vs 21% in NO, P = .03). Despite higher sPTH, OB patients showed higher bone mineral density and a lower rate of osteoporosis (21% vs 35%, P = .05). Differences in the prevalence of hypercalciuria and osteoporosis between the groups persisted after adjustment for age, race, estimated glomerular filtration rate, gender, sPTH, and calcium. Conclusions: In PHPT patients, obesity is a risk factor for hypercalciuria and nephrolithiasis and is protective against osteoporosis. The impact of parathyroidectomy on the clinical features of obese PHPT patients merits further evaluation.

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