• Hien Tran, Jacob S Grange, Beverley Adams-Huet, Fiemu E Nwariaku, Jennifer L Rabaglia, Stacey L Woodruff, Shelby A Holt, and Naim M Maalouf.
• The Charles and Jane Pak Center for Mineral Metabolism and Clinical Research (H.T., J.S.G., N.M.M.), Departments of Internal Medicine (H.T., B.A.-H., N.M.M.), Clinical Sciences (B.A.-H.), and Surgery (F.E.N., J.I.R., S.L.W., S.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390-8885.
• J. Clin. Endocrinol. Metab. 2014 Jul 1; 99 (7): 2359-64.

ContextObesity has been associated with elevated serum PTH (sPTH) in the general population. Obesity may also alter the clinical presentation in patients with primary hyperparathyroidism (PHPT).ObjectivesThe objectives of the study were to compare the clinical presentation of obese (OB) vs nonobese (NO) PHPT patients and to assess the impact of obesity on the presentation of PHPT independent of serum calcium and PTH.PatientsConsecutive PHPT patients who underwent parathyroidectomy between 2003 and 2012 by a single surgical group participated in the study.SettingThe study was conducted at an academic medical center.DesignCross-sectional review of records of preoperative demographic, historical, laboratory, and densitometry findings and intraoperative pathological findings were compared in OB vs NO patients.Main Outcome MeasuresThe prevalence of nephrolithiasis and osteoporosis was measured.ResultsTwo hundred forty-seven PHPT patients were included in this analysis. Fifty percent were OB and 79% were women. Mean body mass index was 25.3 ± 3.3 and 36.0 ± 5.2 kg/m(2) in the NO and OB groups, respectively. Age, gender, and race distribution was similar between the two groups. Serum calcium was similar between the groups (11.0 ± 0.7 mg/dL in NO vs 11.1 ± 0.9 mg/dL in OB, P = .13), whereas sPTH was higher in OB (151 ± 70 vs 136 ± 69 pg/mL, P = .03). The OB group exhibited higher prevalence of hypercalciuria (urine calcium > 400 mg per 24 h) (41% vs 23% in NO, P = .01) and nephrolithiasis (36% vs 21% in NO, P = .03). Despite higher sPTH, OB patients showed higher bone mineral density and a lower rate of osteoporosis (21% vs 35%, P = .05). Differences in the prevalence of hypercalciuria and osteoporosis between the groups persisted after adjustment for age, race, estimated glomerular filtration rate, gender, sPTH, and calcium.ConclusionsIn PHPT patients, obesity is a risk factor for hypercalciuria and nephrolithiasis and is protective against osteoporosis. The impact of parathyroidectomy on the clinical features of obese PHPT patients merits further evaluation.

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