Factors influencing the development of bone starvation syndrome after total parathyroidectomy in patients with renal hyperparathyroidism

Peng, Xiao; Xia, Xiaofang; Li, Zhouting; Cheng, Feng; Zhu, Xi

doi:10.3389/fsurg.2022.963231

Cited by 2 publications

(8 citation statements)

References 20 publications

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“…For instance, we mention a single-center, retrospective study on 141 individuals with RHPT that identified a HBS prevalence of 32% (N1 = 46) following successful PTx with at least 3 parathyroid glands being auto-transplanted. Pre-operative predictors of HBS (univariate analysis) were: higher dialysis age, respectively, increased values of PTH, calcitonin, and AP (which was found to be an independent predictor of HBS; a cutoff of 199.5 U/L offering a sensitivity of 80.85%, and a specificity of 82.61% regarding post-operatory HBS prediction), while pre-surgery PTH was correlated with the duration of intravenous regime of calcium replacement and total calcium dose (via intravenous supplementation) amid HBS [104].…”

Section: Pre-operatory Hbs Predictors In Subjects With Rphtmentioning

confidence: 88%

“…An amount of 23 studies were retrospective and 4 were of prospective, prospective-retrospective type, respectively, longitudinal and a national database cohort. Considering the number of enrolled participants per study, 12 studies included less than 100 participants per study, as follows: 19 (n = 2), 35, 37 (n = 2), 41, 45, 53, 62, 77, 79, 84; 9 studies enrolled between 100 and 200 individuals per study (of 108, 115, 120, 130, 131, 141, 148, 167, and 196), 3 studies had between 200 and 300 patients per study (specifically, 252, 260, and 297) while 3 larger studies had more than 700 patients per study (N = 796, 1846, and 7171), regardless the study design, a total of 12,468 patients with RHPT [1,4,17,30,40,84,85,[104][105][106][107][108][109][110]112,116,117,[123][124][125][126][127][128][129][130][131][132] (Table 5).…”

Section: Post-operatory Findings In Rhpt: Focus On Hbsmentioning

confidence: 99%

“…Table 5. Original studies in patients confirmed with RHPT who developed HBS following PTx; the display starts with the most recent publication [1,4,17,30,40,84,85,[104][105][106][107][108][109][110]112,116,117,[123][124][125][126][127][128][129][130][131][132].…”

Section: Outcome and Management In Rhpt-related Hbsmentioning

confidence: 99%

“…With regard to RHPT, we mention three types of evidence. The first includes risk factors for HBS with a solid level of statistical evidence: younger age at PTx [84,85,105,107,110,112,117,130], pre-operatory elevated level of AP [85,104,105,108,110,112,123,130], and PTH [85,104,105,108,123,127,130], respectively, normal/low serum calcium [85,105,107,108,110]. The second group includes active interventional protocols that either reduce the rate or improve the severity of HBS, in addition to an adequate use of dialysis during early post-operatory stages [123,124,127].…”

Section: Panel Of Investigations In Phpt and Rhpt As Clues For Hbsmentioning

confidence: 99%

“…pre-operatory elevated level of AP [85,104,105,108,110,112,123,130], and PTH [85,104,105,108,123,127,130], respectively, normal/low serum calcium [85,105,107,108,110]. The second group includes active interventional protocols that either reduce the rate or improve the severity of HBS, in addition to an adequate use of dialysis during early post-operatory stages [123,124,127].…”

Section: Panel Of Investigations In Phpt and Rhpt As Clues For Hbsmentioning

confidence: 99%

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Forestalling Hungry Bone Syndrome after Parathyroidectomy in Patients with Primary and Renal Hyperparathyroidism

Cârșote

Nistor

2023

Diagnostics

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Hungry bone syndrome (HBS), severe hypocalcemia following parathyroidectomy (PTX) due to rapid drop of PTH (parathormone) after a previous long term elevated concentration in primary (PHPT) or renal hyperparathyroidism (RHPT), impairs the outcome of underlying parathyroid disease. Objective: overview HBS following PTx according to a dual perspective: pre- and post-operative outcome in PHPT and RHPT. This is a case- and study-based narrative review. Inclusion criteria: key research words “hungry bone syndrome” and “parathyroidectomy”; PubMed access; in extenso articles; publication timeline from Inception to April 2023. Exclusion criteria: non-PTx-related HBS; hypoparathyroidism following PTx. We identified 120 original studies covering different levels of statistical evidence. We are not aware of a larger analysis on published cases concerning HBS (N = 14,349). PHPT: 14 studies (N = 1545 patients, maximum 425 participants per study), and 36 case reports (N = 37), a total of 1582 adults, aged between 20 and 72. Pediatric PHPT: 3 studies (N = 232, maximum of 182 participants per study), and 15 case reports (N = 19), a total of 251 patients, aged between 6 and 18. RHPT: 27 studies (N = 12,468 individuals, the largest cohort of 7171) and 25 case reports/series (N = 48), a total of 12,516 persons, aged between 23 and 74. HBS involves an early post-operatory (emergency) phase (EP) followed by a recovery phase (RP). EP is due to severe hypocalcemia with various clinical elements (<8.4 mg/dL) with non-low PTH (to be differentiated from hypoparathyroidism), starting with day 3 (1 to 7) with a 3-day duration (up to 30) requiring prompt intravenous calcium (Ca) intervention and vitamin D (VD) (mostly calcitriol) replacement. Hypophosphatemia and hypomagnesiemia may be found. RP: mildly/asymptomatic hypocalcemia controlled under oral Ca+VD for maximum 12 months (protracted HBS is up to 42 months). RHPT associates a higher risk of developing HBS as compared to PHPT. HBS prevalence varied from 15% to 25% up to 75–92% in RHPT, while in PHPT, mostly one out of five adults, respectively, one out of three children and teenagers might be affected (if any, depending on study). In PHPT, there were four clusters of HBS indicators. The first (mostly important) is represented by pre-operatory biochemistry and hormonal panel, especially, increased PTH and alkaline phosphatase (additional indicators were elevated blood urea nitrogen, and a high serum calcium). The second category is the clinical presentation: an older age for adults (yet, not all authors agree); particular skeleton involvement (level of case reports) such as brown tumors and osteitis fibrosa cystica; insufficient evidence for the patients with osteoporosis or those admitted for a parathyroid crisis. The third category involves parathyroid tumor features (increased weight and diameter; giant, atypical, carcinomas, some ectopic adenomas). The fourth category relates to the intra-operatory and early post-surgery management, meaning an associated thyroid surgery and, maybe, a prolonged PTx time (but this is still an open issue) increases the risk, as opposite to prompt recognition of HBS based on calcium (and PTH) assays and rapid intervention (specific interventional protocols are rather used in RHPT than in PHPT). Two important aspects are not clarified yet: the use of pre-operatory bisphosphonates and the role of 25-hydroxyitamin D assay as pointer of HBS. In RHPT, we mentioned three types of evidence. Firstly, risk factors for HBS with a solid level of statistical evidence: younger age at PTx, pre-operatory elevated bone alkaline phosphatase, and PTH, respectively, normal/low serum calcium. The second group includes active interventional (hospital-based) protocols that either reduce the rate or improve the severity of HBS, in addition to an adequate use of dialysis following PTx. The third category involves data with inconsistent evidence that might be the objective of future studies to a better understanding; for instance, longer pre-surgery dialysis duration, obesity, an elevated pre-operatory calcitonin, prior use of cinalcet, the co-presence of brown tumors, and osteitis fibrosa cystica as seen in PHPT. HBS remains a rare complication following PTx, yet extremely severe and with a certain level of predictability; thus, the importance of being adequately identified and managed. The pre-operatory spectrum of assessments is based on biochemistry and hormonal panel in addition to a specific (mostly severe) clinical presentation while the parathyroid tumor itself might provide useful insights as potential risk factors. Particularly in RHPT, prompt interventional protocols of electrolytes surveillance and replacement, despite not being yet a matter of a unified, HBS-specific guideline, prevent symptomatic hypocalcemia, reduce the hospitalization stay, and the re-admission rates.

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Section: Pre-operatory Hbs Predictors In Subjects With Rphtmentioning

confidence: 88%

Section: Post-operatory Findings In Rhpt: Focus On Hbsmentioning

confidence: 99%

Section: Outcome and Management In Rhpt-related Hbsmentioning

confidence: 99%

Section: Panel Of Investigations In Phpt and Rhpt As Clues For Hbsmentioning

confidence: 99%

Section: Panel Of Investigations In Phpt and Rhpt As Clues For Hbsmentioning

confidence: 99%

See 3 more Smart Citations

Forestalling Hungry Bone Syndrome after Parathyroidectomy in Patients with Primary and Renal Hyperparathyroidism

Cârșote

Nistor

2023

Diagnostics

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show abstract

Improved Clinical Outcomes Associated With Hungry Bone Syndrome Following Parathyroidectomy in Dialysis Patients

Silarat,

Saeseow,

Pathumarak

et al. 2024

Endocrine Practice

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Factors influencing the development of bone starvation syndrome after total parathyroidectomy in patients with renal hyperparathyroidism

Cited by 2 publications

References 20 publications

Forestalling Hungry Bone Syndrome after Parathyroidectomy in Patients with Primary and Renal Hyperparathyroidism

Forestalling Hungry Bone Syndrome after Parathyroidectomy in Patients with Primary and Renal Hyperparathyroidism

Improved Clinical Outcomes Associated With Hungry Bone Syndrome Following Parathyroidectomy in Dialysis Patients

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