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Refractory Hypocalcemia Following Stomach Intestinal Pylorus-Sparing Bariatric Surgery and Thyroidectomy: Successful Management With Creation of a Proximal Roux-en-Y Gastric Bypass.

Authors
  • Jensen, Stephanie M1
  • Thompson, Richard E2
  • Machineni, Sriram3
  • Overby, David W2
  • Farrell, Timothy M2
  • 1 University of North Carolina School of Medicine, Chapel Hill, NC, USA.
  • 2 Department of Surgery, 2331University of North Carolina, Chapel Hill, NC, USA.
  • 3 Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
Type
Published Article
Journal
The American surgeon
Publication Date
Apr 01, 2021
Volume
87
Issue
4
Pages
576–580
Identifiers
DOI: 10.1177/0003134820952427
PMID: 33125276
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Some forms of bariatric surgery make patients susceptible to calcium malabsorption, and the parathyroid hormone (PTH) axis is important for maintaining normocalcemia in these patients. Injury to the parathyroid glands due to anterior neck surgery commonly causes PTH axis disruption and can result in severe hypocalcemia in bariatric surgery patients. Herein, we present a case of a patient with a history of stomach intestinal pylorus-sparing bariatric surgery who developed refractory hypocalcemia requiring daily intravenous (IV) calcium 2 years after thyroidectomy. PTH levels were inappropriately normal during episodes of hypocalcemia, and urinary calcium level was <3.0 mg/dL following large oral doses of calcium, suggesting that both inadequate PTH response and malabsorption contributed to her severe hypocalcemia. In order to enhance calcium absorptive capacity while minimizing the risk of weight regain, she was surgically treated with a Roux-en-Y gastric bypass proximal to the prior operation. The surgery successfully improved blood calcium levels; the patient was successfully weaned from IV calcium and was able to maintain normocalcemia with oral supplements. We discuss the case in the context of available literature and provide our recommendations.

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