Skip to main content
SpringerLink
Log in

Postoperative Hungry Bone Syndrome in Patients with Secondary Hyperparathyroidism of Renal Origin

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Hungry bone syndrome (HBS) is a postoperative condition of severe hypocalcemia that can be seen in patients who have undergone parathyroidectomy (PTX) for secondary hyperparathyroidism (2HPT) of renal origin. This study examines HBS in patients after PTX for 2HPT.

Methods

Prospectively collected data was retrospectively reviewed in patients who underwent PTX for 2HPT of renal origin at a single institution. HBS was defined as the need for additional days of hospitalization or readmission for intravenous calcium supplementation due to clinical symptoms of hypocalcemia, including tingling, muscle spasms, and bone pain and/or immediate postoperative low serum calcium ≤7.5 mg/dl.

Results

Of 79 patients who underwent PTX for 2HPT, 27.8% (n = 22) experienced HBS. Young age (≤45 years, p = 0.02) was the only preoperative variable that predicted HBS. Most patients developed HBS within 18 h after surgery and required a prolonged hospital stay (19/22) compared to those requiring hospital readmission within the first 7 days (3/22). Initial postoperative serum calcium levels within 18 h of surgery were significantly lower in those patients who developed HBS (7.1 vs. 8.3 mg/dl, p = 0.001), and those patients also had a greater absolute decrease in serum calcium (2.8 vs. 3.5 mg/dl, p = 0.04).

Conclusion

HBS develops in a significant proportion of patients generally within the first 18 h after subtotal PTX for 2HPT. The only identifiable preoperative risk factor for HBS was young age. Additionally, low initial calcium levels and greater absolute decrease in serum calcium may help identify those patients that will develop HBS requiring judicious calcium supplementation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Pappenheimer AM, Wilens SL (1934) Enlargement of the parathyroid glands in renal disease. Am J Pathol 11(1):73–91

    Google Scholar 

  2. Albright F, Baird PC, Cope O et al (1934) Studies on the physiology of the parathyroid glands. IV. Renal complications of hyperparathyroidism. Am J Med Sci 187:49–65

    Article  Google Scholar 

  3. Stanbury SW, Lumb GA, Nicolson WF (1960) Elective subtotal parathyroidectomy for renal hyperparathyroidism. Lancet 1:793–798

    Article  PubMed  CAS  Google Scholar 

  4. Alveryd A (1968) Parathyroid glands in thyroid surgery. Acta Chir Scand 389:1–120

    PubMed  CAS  Google Scholar 

  5. Wells SA Jr, Gunnells JC, Shelburne JD et al (1975) Transplantation of the parathyroid glands in man: clinical indications and results. Surgery 78:34–44

    PubMed  Google Scholar 

  6. Torer N, Torun D, Micozkadioglu T et al (2009) Predictors of early postoperative hypocalcemia in hemodialysis patients with secondary hyperparathyroidism. Transplant Proc 41:3642–3646

    Article  PubMed  CAS  Google Scholar 

  7. National Kidney Foundation K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease (2004). Available at http://www.kidney.org/professionals/KDOQI/guidelines_bone/Guide14.htm. Accessed 7 Jan 2011

  8. Cheng SP, Liu CL, Chen HH et al (2009) Prolonged hospital stay after parathyroidectomy for secondary hyperparathyroidism. World J Surg 33:72–79. doi:10.1007/s00268-008-9787-2

    Article  PubMed  Google Scholar 

  9. Kestenbaum B, Seliger SL, Gillen DL et al (2004) Parathyroidectomy rates among United States dialysis patients: 1990–1999. Kidney Int 65:282–288

    Article  PubMed  Google Scholar 

  10. Malberti A, Marcelli D, Conte F et al (2001) Parathyroidectomy in patients on renal replacement therapy: an epidemiologic study. J Am Soc Nephrol 12:1242–1248

    PubMed  CAS  Google Scholar 

  11. Cunningham J, Danese M, Olson K et al (2005) Effects of the calcimimetic Sensipar HCL on cardiovascular disease, fracture, and health-related quality of life in secondary hyperparathyroidism. Kidney Int 68:1793–1800

    Article  PubMed  CAS  Google Scholar 

  12. Foley RN, Li S, Liu J et al (2005) The fall and rise of parathyroidectomy in U.S. hemodialysis patients, 1992 to 2002. J Am Soc Nephrol 16:210–218

    Article  PubMed  Google Scholar 

  13. Mittendorf EA, Merlino JI, McHenry CR (2004) Post-parathyroidectomy hypocalcemia: incidence, risk factors, and management. Am Surg 70:114–120

    PubMed  Google Scholar 

  14. Jofre R, Gomez JM, Menárguez J et al (2003) Parathyroidectomy: whom and when? Kidney Int 63(S85):S97–S100

    Article  Google Scholar 

  15. Viaene L, Evenepoel P, Bammens B et al (2008) Calcium requirements after parathyroidectomy in patients with refractory secondary hyperparathyroidism. Nephon Clin Pract 110:c80–c85

    Article  CAS  Google Scholar 

  16. Albright F, Reifenstein EC (1948) The parathyroid glands and metabolic bone disease: selected studies. Williams & Wilkins, Baltimore

    Google Scholar 

  17. Brasier AR, Nussbaum SR (1988) Hungry bone syndrome: clinical and biochemical predictors of its occurrence after parathyroid surgery. Am J Med 84:654–660

    Article  PubMed  CAS  Google Scholar 

  18. Cruz DN, Perazella MA (1997) Biochemical aberrations in a dialysis patient following parathyroidectomy. Am J Kidney Dis 29(5):759–762

    Article  PubMed  CAS  Google Scholar 

  19. Nakagawa M, Emoto A, Nasu N et al (2000) Calcium supplementation necessary to correct hypocalcemia after total parathyroidectomy for renal osteodystrophy. Int J Urol 7:35–40

    Article  PubMed  CAS  Google Scholar 

  20. Delmonico FL, Wang CA, Rubin NT et al (1984) Parathyroid surgery in patients with renal failure. Ann Surg 200(5):644–647

    Article  PubMed  CAS  Google Scholar 

  21. Narayan R, Perkins RM, Berbano EP (2007) Parathyroidectomy versus cinacalcet hydrochloride-based medical therapy in management of hyperparathyroidism in ESRD. A cost utility analysis. Am J Kidney Dis 48:801–813

    Article  Google Scholar 

  22. Cozzolino M, Gallieni M, Corsi C et al (2004) Management of calcium refilling post-parathyroidectomy in end-stage renal disease. J Nephrol 17:3–8

    PubMed  CAS  Google Scholar 

  23. Clair F, Leenhardt L, Bordeau A et al (1987) Effect of calcitriol in the control of plasma calcium after parathyroidectomy: a placebo-controlled, double-blind study in chronic hemodialysis patients. Nephron 46:18–22

    Article  PubMed  CAS  Google Scholar 

  24. Mazzaferro S, Chicca S, Pasquali M (2000) Changes in bone turnover after parathyroidectomy in dialysis patients: role of calcitriol administration. Nephrol Dial Transplant 15:877–882

    Article  PubMed  CAS  Google Scholar 

  25. Gasparri G, Camandona M, Abbona GC et al (2001) Secondary and tertiary hyperparathyroidism: causes of recurrent disease after 446 parathyroidectomies. Ann Surg 233(1):65–69

    Article  PubMed  CAS  Google Scholar 

  26. Tominga Y, Tanaka Y, Sato K et al (1997) Histopathology, pathophysiology, and indications for surgical treatment of renal hyperparathyroidism. Semin Surg Oncol 1:78–86

    Google Scholar 

  27. Punch JD, Thompson NW, Merion RM (1995) Subtotal parathyroidectomy in dialysis-dependent and post-renal transplant patients. Arch Surg 130:538–543

    Article  PubMed  CAS  Google Scholar 

  28. Richards ML, Wormuth J, Bingener J et al (2006) Parathyroidectomy in secondary hyperparathyroidism: is there an optimal management? Surgery 139(2):174–180

    Article  PubMed  Google Scholar 

  29. Shih ML, Duh QY, Hsieh CB et al (2009) Total parathyroidectomy without autotransplantation for secondary hyperparathyroidism. World J Surg 33:248–254. doi:10.1007/s00268-008-9765-8

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Endocrine Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA

    Melanie Goldfarb, Susan M. Lim, Josephina C. Farra & John I. Lew

  2. Division of Breast/Soft Tissue and Endocrine Surgery, Department of Surgery, University of Southern California Keck School of Medicine, 1441 Eastlake Ave, Suite 3411, Los Angeles, CA, 90033, USA

    Melanie Goldfarb

  3. Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Stephan S. Gondek

  4. Division of Endocrine Pathology, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA

    Vania Nose

Authors
  1. Melanie Goldfarb
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephan S. Gondek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Susan M. Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Josephina C. Farra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vania Nose
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. John I. Lew
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Melanie Goldfarb.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goldfarb, M., Gondek, S.S., Lim, S.M. et al. Postoperative Hungry Bone Syndrome in Patients with Secondary Hyperparathyroidism of Renal Origin. World J Surg 36, 1314–1319 (2012). https://doi.org/10.1007/s00268-012-1560-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-012-1560-x

Keywords

Search

Navigation