Hungry bone syndrome: Clinical and biochemical predictors of its occurrence after parathyroid surgery

  • Allan R. Brasier
    Endocrine Unit and Medical Services, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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  • Samuel R. Nussbaum
    Requests for reprints should be addressed to Dr. Samuel R. Nussbaum, Massachusetts General Hospital, Endocrine Unit, Wellman 5, Boston, Massachusetts 02114.
    Endocrine Unit and Medical Services, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
    Search for articles by this author
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      The hospital course of 218 consecutive patients with primary hyperparathyroidism admitted over a three-year period for parathyroidectomy at the Massachusetts General Hospital was reviewed to determine the incidence and identify the risk factors for the development of the hungry bone syndrome. Twenty-five patients with the hungry bone syndrome were identified (12.6 percent). Compared to patients with uncomplicated metabolic responses to parathyroid surgery, these patients were older by a mean of 10 years; they had higher preoperative serum levels of calcium, alkaline phosphatase, N-terminal parathyroid hormone, and blood urea nitrogen; and their resected parathyroid adenomata were larger. The mean duration of hospitalization averaged three days longer in the group with hungry bone disease. Stepwise multivariate analysis of preoperative variables enabled the development of a discriminant function for prediction of postoperative hypocalcemia and hypophosphatemia. Identified predictive variables were volume of resected parathyroid adenoma, blood urea nitrogen, alkaline phosphatase, and age. When validated on an independent patient population, these readily obtainable preoperative clinical and laboratory parameters will allow identification of a subgroup of patients who are at greater risk for the development of the hungry bone syndrome following parathyroid surgery.
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