Reversal of Roux-en-Y Gastric Bypass Fails to Facilitate the Management of Recalcitrant Hypocalcaemia Caused by Primary Hypoparathyroidism

Corbeels, Katrien; Steenackers, Nele; Lannoo, Matthias; Mertens, Ann; Deleus, Ellen; Cunha, Nelson; Sinonquel, Pieter; Matthys, Christophe; Meulemans, Ann; Vangoitsenhoven, Roman; Van der Schueren, Bart

doi:10.1007/s11695-020-04903-8

Reversal of Roux-en-Y Gastric Bypass Fails to Facilitate the Management of Recalcitrant Hypocalcaemia Caused by Primary Hypoparathyroidism

Author:

Corbeels, Katrien

Steenackers, Nele ; Lannoo, Matthias ; Mertens, Ann ; Deleus, Ellen ; Cunha, Nelson ; Sinonquel, Pieter ; Matthys, Christophe ; Meulemans, Ann ; Vangoitsenhoven, Roman ; Van der Schueren, Bart

Keywords:

Science & Technology, Life Sciences & Biomedicine, Surgery, Bariatric surgery, Roux-en-Y gastric bypass, Thyroidectomy, Parathyroid hormone, Calcium, THYROIDECTOMY, HYPOGLYCEMIA, Female, Gastric Bypass, Humans, Hypocalcemia, Hypoparathyroidism, Obesity, Morbid, 1103 Clinical Sciences, 1117 Public Health and Health Services, 3202 Clinical sciences, 3210 Nutrition and dietetics, 4206 Public health

Abstract:

Roux-en-Y gastric bypass (RYGB) is thought to reduce calcium absorption from the gut. Here, we report the case of a patient with a RYGB, who developed primary hypoparathyroidism after a total thyroidectomy, leading to recalcitrant hypocalcaemia. Despite aggressive oral calcium and calcitriol supplementation, she remained hypocalcaemic and required intravenous (IV) calcium supplementation to control her symptoms, and to keep calcium serum levels within an acceptable range. Teriparatide treatment improved calcium levels marginally. This treatment, however, was poorly tolerated and ultimately stopped by the patient. As a last resort, reversal of RYGB was performed to improve calcium absorption from the gut. Unfortunately, IV calcium supplementation remained necessary. This case illustrates that the reversal of RYGB is not always a guarantee for success in managing recalcitrant hypocalcaemia.