The impact of body mass index on the diagnostic and surgical outcomes in primary hyperparathyroidism

TL;DR

This study shows that body mass index affects diagnostic and surgical outcomes in patients with primary hyperparathyroidism.

Contribution

The study reveals that normal-weight patients have higher parathormone levels and more postoperative complications than those with higher BMI.

Findings

Normal-weight patients had higher preoperative parathormone levels than morbidly obese patients.

Osteoporosis rates were highest in normal-weight patients and lowest in morbidly obese patients.

Symptomatic hypocalcemia occurred more frequently in normal-weight patients compared to obese patients.

Abstract

The aim of this study was to investigate the influence of body mass index on the diagnostic and surgical outcomes in patients undergoing parathyroidectomy for primary hyperparathyroidism.

A total of 446 patients with primary hyperparathyroidism were divided into four groups according to their body mass index: normal weight (body mass index<25 kg/m2) (n=130), overweight (25≤body mass index<30 kg/m2) (n=166), obese (30≤body mass index<35 kg/m2) (n=112), and morbidly obese (body mass index≥35 kg/m2) (n=38). Perioperative findings were compared between the groups.

The preoperative median parathormone level in the morbidly obese group (204 pg/mL, min:max 72:1,178) was significantly lower than that in the normal-weight (246 pg/mL, min:max 60:4,262) (p=0.026) and obese (251 pg/mL, min:max 74:2,094) (p=0.012) groups. The osteoporosis rate in the normal-weight group (51%) was higher than that in the overweight (35.4%) (p=0.041) and morbidly obese (25%) (p=0.023) groups. The symptomatic hypocalcemia rate in the normal-weight group (10.2%) was significantly higher than that in the obese group (1.8%) (p=0.017).

Normal-weight patients with primary hyperparathyroidism have higher blood parathormone values, higher rates of osteoporosis, and postoperative symptomatic hypocalcemia compared to patients with higher body mass index. For this reason, the surgeon should consider the possibility of symptomatic hypocalcemia after undergoing parathyroidectomy for primary hyperparathyroidism in normal-weight cases.