PSAT167 Asian-Indians With Symptomatic Primary Hyperparathyroidism Have Lower Body Weight At Presentation And Tend To Gain Weight Post-Curative Parathyroidectomy
Authors: Pal Rimesh , Bhadada Sanjay Kumar , Kumari Poonam , Dahiya Divya , Sood Ashwani 
Published: November 2022

Abstract
Patients with primary hyperparathyroidism (PHPT) have higher body weight than their eucalcemic peers (1). However, most of the data is based on Caucasian PHPT patients who predominantly have an asymptomatic presentation. Similar data from Asian-Indian patients with PHPT who primarily have symptomatic disease are unavailable. In this regard, we planned to conduct a retrospective observational study to look into the dynamics of body weight in Asian-Indian PHPT patients. The medical records of PHPT patients (≥18 years) managed at Postgraduate Institute of Medical Education and Research, India, from July 2005 to December 2020 were retrieved from the Indian PHPT Registry (www.indianphptregistry.com). Patients who had achieved biochemical cure after parathyroidectomy with documentation of preoperative and at least one postoperative body weight 6 months to 2 years after surgery were included. Patients with recurrent/persistent/syndromic PHPT, chronic kidney disease (eGFR &lt;90 ml/min/1.73 m2), parathyroid carcinoma, and incomplete records were excluded. After exclusion, a total of 243 patients were included in analysis (mean age=43.9±13.7 years, women 79.8%). The majority of the patients had symptomatic disease, while only 43 patients (18%) were asymptomatic at presentation. The predominant presenting manifestations were renal stone disease (52%), bone pain (40%), gastrointestinal symptoms (anorexia, nausea, vomiting, constipation) (30%), generalized weakness (26%), weight loss (23%), fragility fractures (16%), cholelithiasis (13%) and acute pancreatitis (7%). The mean preoperative body weight was 59.9±13.4 kg. Patients with PHPT had lower body weight compared to an equal number (n=243) of age- and sex-matched community-dwelling healthy controls (p&lt;0.001 for both men and women). At median follow-up of 1 year, the mean postoperative body weight was 64.7±12.6 kg. The median (interquartile range) percent change is body weight was +6.7% (+2.1, +14.0). Increase in body weight was noted in 198 patients (81.5%). Univariate analysis showed that patients with postoperative weight gain were younger (p=0.029), had lower body weight (p&lt;0.001), were more likely to be symptomatic (p=0.002), and more likely to have weight loss (p=0.041) and gastrointestinal symptoms (p=0.016) at presentation compared with patients with no weight gain. Similarly, patients with weight gain had significantly higher preoperative serum calcium (p=0.044), alkaline phosphatase (ALP) (p=0.001), and parathyroid hormone levels (p=0.001), indicating biochemically severe disease On binomial logistic regression analysis, preoperative body weight (β= -0.045, p=0.04), symptomatic presentation (β=0.217, p=0.02), and ALP (β=0.003, p=0.04) emerged as significant predictors of postoperative weight gain. In conclusion, Asian-Indians with symptomatic PHPT have lower body weight than healthy controls, likely because of significant gastrointestinal manifestations that compromise food intake. It is plausible that following reinstatement of eucalcemia, appetite improves, resulting in increased food intake and subsequent weight gain. Nevertheless, long-term follow-up studies evaluating the metabolic consequences of this postoperative weight gain are needed.Reference: (1) Bolland et al., J Clin Endocrinol Metab. 2005;90(3): 1525–30.
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