Severe Refractory Hypocalcemia after Parathyroidectomy for Hyperparathyroidism and Parathyroid Adenoma in a Patient with Prior Bariatric Surgery: A Rare Case Report

Majdi Al Najjar¹, Mousa Suhail Abu Ghoush^2, , Nadeen Elmajed², Ahmed Eldimllawi², Ahmed Abousalha² and Yousef almehrzi¹

¹Endocrine, Zayed Military Hospital, Abudhabi, United Arab Emirates

²Internal Medicine, Zayed Military Hospital, Abudhabi, United Arab Emirates

Cite this paper

Majdi Al Najjar, Mousa Suhail Abu Ghoush, Nadeen Elmajed, Ahmed Eldimllawi, Ahmed Abousalha and Yousef almehrzi. Severe Refractory Hypocalcemia after Parathyroidectomy for Hyperparathyroidism and Parathyroid Adenoma in a Patient with Prior Bariatric Surgery: A Rare Case Report. American Journal of Medical Case Reports. 2021; 9(11):664-666. doi: 10.12691/AJMCR-9-11-12

Abstract

Hypocalcaemia is a common but transient complication post Parathyroid surgery. In patients who have gone through bariatric surgery including Roux-En-Y the risk increases further. We present a challenging case report of a patient with history of RYGB who underwent parathyroidectomy and consequently developed refractory hypocalcaemia. Hypocalcaemia was managed conservatively initially but subsequently required higher doses of both intravenous and oral calcium along with teriparatide. Patients post Bariatric surgery including those who have undergone Roux-en-Y who are proceeding with Parathyroid procedures should be followed up closely for hypocalcaemia.

Keywords

Roux-en-Y, post parathyroidectomy, hypocalcaemia, refractory, teriparatide, bariatric surgery

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Schafer AL, Weaver CM, Black DM, et al. Intestinal calcium absorption decreases dramatically after gastric bypass surgery despite optimization of vitamin D status. J Bone Miner Res 2015; 30(8): 1377-1385.
[2]	Alexandrou A, Tsoka E, Armeni E, Rizos D, Diamantis T, Augoulea A, et al. Determinants of secondary hyperparathyroidism in bariatric patients after Roux-en-Y gastric bypass or sleeve gastrectomy: a pilot study. Int J Endocrinol 2015; 2015: 984935.
[3]	Avgerinos DV, Leitman IM, Martı´nez RE, Liao EP. Evaluation of markers for calcium homeostasis in a population of obese adults undergoing gastric bypass operations. J Am Coll Surg 2007; 205: 294-297.
[4]	Does Bariatric Surgery Increase the Formation of Parathyroid Adenoma.Müge Keskin, Doğan Öztürk, Arzu Or Koca, Derun Taner Ertuğrul, and Hakan Bulus.Bariatric Surgical Practice and Patient Care 2020 15: 3, 155-159.
[5]	Fuss CT, Burger-Stritt S, Horn S, et al. Continuous rhPTH (1-34) treatment in chronic hypoparathyroidism [published online ahead of print, 2020 May 29]. Endocrinol Diabetes Metab Case Rep. 2020; 2020: EDM20-0009.
[6]	Brasier AR, Nussbaum SR. Hungry bone syndrome: clinical and biochemical predictors of its occurrence after parathyroid surgery. Am J Med. 1988 Apr; 84(4): 654-60.
[7]	Wei JH, Lee WJ, Chong K, Lee YC, Chen SC, Huang PH, Lin SJ. High Incidence of Secondary Hyperparathyroidism in Bariatric Patients: Comparing Different Procedures. Obes Surg. 2018 Mar; 28(3): 798-804.