Association between body mass index and multigland primary hyperparathyroidism

Area of Science:

• Endocrinology
• Surgical Oncology
• Metabolic Disorders

Background:

• Multigland disease (MGD) constitutes 15% of sporadic primary hyperparathyroidism (pHPT) cases.
• Obesity is linked to altered calcium metabolism and increased pHPT incidence.
• Obese patients face higher rates of reoperation for persistent or recurrent pHPT.

Purpose of the Study:

• To investigate the association between obesity and the prevalence of MGD in patients with sporadic pHPT.
• To identify predictors of MGD in the context of obesity and primary hyperparathyroidism.

Main Methods:

• Retrospective review of a prospectively collected parathyroid database (1999-2013).
• Inclusion of adult patients with sporadic pHPT undergoing initial parathyroidectomy.
• Assessment of demographic, clinicopathologic, operative, and laboratory data for MGD associations.

Main Results:

• Of 1305 patients, 15% (200) had MGD.
• Multivariate analysis identified higher Body Mass Index (BMI) as a predictor of MGD (OR 1.5 for BMI 30-39.9; OR 1.8 for BMI ≥40).
• Smaller size of the first excised parathyroid gland was also associated with MGD (OR 0.7).

Conclusions:

• Obesity and morbid obesity are associated with a higher incidence of MGD in pHPT.
• Surgeons should consider bilateral exploration in obese patients due to increased MGD risk.
• A lower threshold for bilateral exploration is recommended, especially if the initial parathyroid gland is small.