Response to oral sucrosomial iron supplementation in patients undergoing bariatric surgery. The BARI-FER study / Respuesta a la suplementación oral con hierro sucrosomado en pacientes sometidos a cirugía bariátrica. Estudio BARI-FER

Background: Chronic intravenous iron administration is often required after bariatric surgery. Oral sucrosomial iron has a particular form of absorption and may represent an alternative treatment. Objective: To assess the effect of switching to oral sucrosomial iron in patients receiving intravenous iron supplementation after bariatric surgery. Patients and methods: A case-control study was conducted on 40 women of childbearing age, of whom 20 were switched to oral sucrosomial iron, while 20 patients continued on intravenous iron sucrose every three months. Results: No significant differences were seen in Hb, ferritin, and TSI levels before and after three months of treatment with sucrosomial iron. Conclusion: Oral sucrosomial iron could be an alternative in patients who require parenteral treatment with iron after bariatric surgery (AU)

Antecedentes: A menudo es necesaria la administración intravenosa crónica de hierro después de la cirugía bariátrica. El hierro sucrosomado oral tiene una forma especial de absorción y es un posible tratamiento alternativo. Objetivo: Valorar el efecto del cambio al hierro sucrosomado oral en los pacientes que reciben suplementos de hierro por vía intravenosa después de cirugía bariátrica. Pacientes y métodos: Se realizó un estudio de casos y controles que incluyó a 40 mujeres en edad fértil, de la que 20 se cambiaron a hierro sucrosomado oral, mientras que las 20 restantes siguieron recibiendo hierro sacarosa cada tres meses. Resultados: No se observaron diferencias importantes en los niveles de Hb, ferritina ni TSI hallados antes y después de tres meses de tratamiento con hierro sucrosomado. Conclusión: El hierro sucrosomado oral puede ser una alternativa en los pacientes que necesitan tratamiento parenteral con hierro después de cirugía bariátrica (AU)

Response to oral sucrosomial iron supplementation in patients undergoing bariatric surgery. The BARI-FER study.

BACKGROUND: Chronic intravenous iron administration is often required after bariatric surgery. Oral sucrosomial iron has a particular form of absorption and may represent an alternative treatment. OBJECTIVE: To assess the effect of switching to oral sucrosomial iron in patients receiving intravenous iron supplementation after bariatric surgery. PATIENTS AND METHODS: A case-control study was conducted on 40 women of childbearing age, of whom 20 were switched to oral sucrosomial iron, while 20 patients continued on intravenous iron sucrose every three months. RESULTS: No significant differences were seen in Hb, ferritin, and TSI levels before and after three months of treatment with sucrosomial iron. CONCLUSION: Oral sucrosomial iron could be an alternative in patients who require parenteral treatment with iron after bariatric surgery.

Brown tumor of the jaw after pregnancy and lactation in a MEN1 patient.

Skeletal manifestations of primary hyperparathyroidism (pHPT) include brown tumors (BT), which are osteoclastic focal lesions often localized in the jaws. Brown tumors are a rare manifestation of pHTP in Europe and USA; however, they are frequent in developing countries, probably related to vitamin D deficiency and longer duration and severity of disease. In the majority of cases, the removal of the parathyroid adenoma is enough for the bone to remineralize, but other cases require surgery. Hyperparathyroidism in MEN1 develops early, and is multiglandular and the timing of surgery remains questionable. To our knowledge, there are no reports of BT in MEN 1 patients. We present a 29-year-old woman with MEN 1 who developed a brown tumor of the jaw 24 months after getting pregnant, while breastfeeding. Serum corrected calcium remained under 2.7 during gestation, and at that point reached a maximum of 2.82 mmol/L. Concomitant PTH was 196 pg/mL, vitamin D 13.7 ng/mL and alkaline phosphatase 150 IU/L. Bone mineral density showed osteopenia on spine and femoral neck (both T-scores = -1.6). Total parathyroidectomy was performed within two weeks, with a failed glandular graft autotransplantation, leading to permanent hypoparathyroidism. Two months after removal of parathyroid glands, the jaw tumor did not shrink; thus, finally it was successfully excised. We hypothesize that higher vitamin D and mineral requirements during maternity may have triggered an accelerated bone resorption followed by appearance of the jaw BT. We suggest to treat pHPT before planning a pregnancy in MEN1 women or otherwise supplement with vitamin D, although this approach may precipitate severe hypercalcemia. LEARNING POINTS: Brown tumors of the jaw can develop in MEN 1 patients with primary hyperparathyroidism at a young age (less than 30 years).Pregnancy and lactation might trigger brown tumors by increasing mineral and vitamin D requirements.Early parathyroidectomy is advisable in MEN 1 patients with primary hyperparathyroidism, at least before planning a pregnancy.Standard bone mineral density does not correlate with the risk of appearance of a brown tumor.Removal of parathyroid glands does not always lead to the shrinkage of the brown tumor, and surgical excision may be necessary.