Secondary hyperparathyroidism (hPTH) is common following bariatric procedures, especially those with more distal bypasses like the single anastomosis duodenoileostomy with sleeve gastrectomy (SADI-S). Setting: Private practice in Raleigh, NC
Patients undergoing SADI-S between December 1st, 2020 and September 30th, 2021 were included. PTH and 25-OH vitamin D (Vit D) levels were obtained preoperatively (preop) and at 3, 6, and 12 months postoperatively. Patients were placed on a vitamin regimen consisting of a multivitamin high in vitamins A,D,E,K, calcium citrate 2400 mg, and dry vitamin D3 (cholecalciferol) 30,000 IU daily, total.
Preoperatively, 42.5% (n=17/40) of patients had hPTH and 100% of those had a preop Vit D level <60 (ng/ml). The average Vit D level in the hPTH group was 19 and in the normal PTH group was 31 (p=0.005). Of the patients with preop hPTH, 86% (n=12/14) were normalized at 3 months. The two patients with persistent hPTH had Vit D <60. At 6 months, hPTH resolved in 1 of these patients with an increase in Vit D from 57 to 85. In the patient without resolution of hPTH, the Vit D decreased from 23 to 18. Of the group that did not have hPTH preop (n=23), none (n=18) developed hPTH at 3 months (avg Vit D=98). And none (n=6) developed hPTH at 6 months (avg. Vit D=83).
In short term follow-up after SADI-S, the vast majority of secondary hPTH cases can be corrected and prevented by achieving Vit D levels >60.