Risk factors of developing the hungry bone syndrome after parathyroidectomy for primary hyperparathyroidism

Abstract

Background.Around 13% of patients undergoing parathyroidectomy for primary hyperparathyroidism (PHPT) postoperatively develop a condition known as the hungry bone syndrome (HBS). Although the condition is quite prevalent, the research in this field is very limited. The aim of our study was to determine possible risk factors of developing HBS after parathyroidectomy for PHPT.Materials and methods.In this study we enrolled patients who underwent parathyroidectomy for PHPT from January 2005 to December 2016 and performed a retrospective analysis. We used the definition of HBS as hypocalcaemia with normal or elevated PTH values. Patients were divided into two groups by the postoperative HBS prevalence: patients with postoperative HBS and those without postoperative HBS.Results.In all, 94 patients were included into the final analysis. We found that patients who developed HBS more often underwent parathyroidectomies simultaneously with a thyroid surgery, underwent longer operations (73.9 ± 41.7 vs. 102.4 ± 44.8 minutes; p = 0.001), and had heavier parathyroid glands removed (0.6 (0.3–8.0) vs. 0.8 (0.15–14.0) g; p = 0.041). Also, these patients had higher preoperative PTH values (15.3 (6.1–63.7) vs. 22.4 (9.2–47.8) pmol/l; p = 0.003). From the ROC curve of the preoperative PTH values and the development of the hungry bone syndrome (AUC = 0.721 (95% CI 0.59–0.85); p = 0.003) we found a 45 pmol/l PTH cut-off value that shows a 90% tendency to develop postoperative HBS.Conclusions.Patients undergoing longer parathyroidectomies and those with heavier removed parathyroid glands tend to develop HBS. A preoperative PTH value higher than 45 pmol/l determines an over 90% risk of developing HBS.

Effects of parathyroidectomy on tumoral calcinosis in uremic patients with secondary hyperparathyroidism

“…After PTX, we assessed serum calcium, phosphate and iPTH levels on day 7 and at 3 and 6 months. Hungry-bone syndrome (HBS) was defined as hypocalcemia with corrected serum calcium level < 2.0 mmol/L after PTX [13]. We performed plain radiography or CT scanning during follow-up.…”

The case of late diagnosis of giant parathyroid adenoma in combination with fibrocystic osteitis and brown tumor of the upper jaw: a case report

“…Проявляется длительной гипокальциемией с развитием клинических симптомов (парестезии и судорожная активность) [13]. Факторами риска развития данного синдрома являются: поражение скелета с тяжелым остеопорозом, гигантские размеры аденомы ОЩЖ, одномоментная операция на ОЩЖ и ЩЖ, более высокие предоперационные уровни иПТГ [19,20]. У нашей пациентки главную роль в развитии послеоперационной гипокальциемии сыграло тяжелое поражение скелета с развитием фиброзно-кистозного остеита.…”

Primary hyperparathyroidism

“…Patients who do not receive surgical or medical treatment should be followed up periodically, and should be applied without delay when treatment indication develops. Biochemical tests (serum calcium, creatinine, GFR) of these patients are recommended to be performed annually, BMD follow-up is performed once in 1 or 2 years [30][31][32][33][34][35].…”

“…Some guidelines and studies suggest preoperative vitamin D replacement and the use of bisphosphonates to reduce HBS risk. These agents reduce bone demineralization[25,26].Medical treatment indications in PHPT are: > 50 years of age, the patient is minimally symptomatic or asymptomatic, calcium is <1.0 mg / dl higher than the normal upper limit, has no surgical indication or the patient does not want surgery or the patient is not suitable for surgery. In these situations, patients are followed up by medical monitoring…”