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

  • Allan R. Brasier
    Affiliations
    Endocrine Unit and Medical Services, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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  • Samuel R. Nussbaum
    Correspondence
    Requests for reprints should be addressed to Dr. Samuel R. Nussbaum, Massachusetts General Hospital, Endocrine Unit, Wellman 5, Boston, Massachusetts 02114.
    Affiliations
    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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      Abstract

      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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      References

        • Heath III, M
        • Hodgson SF
        • Kennedy MA
        Primary hyperparathyroidism: incidence, morbidity and potential impact in a community.
        N Engl J Med. 1980; 302: 189-193
        • Purnell D
        • Smith LH
        • Scholz DA
        • Elveback LR
        • Arnaud CD
        Primary hyperparathyroidism: a prospective clinical study.
        Am J Med. 1971; 50: 670-678
        • Scholz DA
        • Purnell DC
        Asymptomatic primary hyperparathyroidism.
        Mayo Clin Proc. 1981; 56: 473-478
        • Albright F
        • Reifenstein Jr, EC
        The parathyroid glands and metabolic bone disease.
        William and Wilkins, Baltimore1948
        • Falko JM
        • Bush CA
        • Tzagournis M
        • Thomas FB
        Congestive heart failure complicating the hungry bone syndrome.
        Am J Med Sci. 1976; 271: 85-89
        • Dent CE
        Some problems of hyperparathyroidism.
        Br Med J. 1962; 2: 1419-1425
        • Wang CA
        Surgical management of primary hyperparathyroidism.
        Curr Probl Surg. 1985; 22: 1-50
      1. Normal laboratory values.
        N Engl J Med. 1986; 314 (Case records of the Massachusetts General Hospital): 39-49
        • Butch RJ
        • Simeone JF
        • Mueller PR
        Thyroid and parathyroid ultrasonography.
        Radiol Clin North Am. 1985; 23: 57-72
        • Godfrey K
        Statistics in practice: comparing the means of several groups.
        N Engl J Med. 1985; 313: 1450-1456
        • Kaplan EL
        • Bartlett S
        • Sugimoto J
        • Fredland A
        Relation of postoperative hypocalcemia to operative techniques: deleterious effect of excessive use of parathyroid biopsy.
        Surgery. 1982; 92: 827-834
        • Wexler MJ
        Surgical considerations in hyperparathyroidism: current concepts.
        Can J Surg. 1978; 21: 290-294
        • Anderberg B
        • Gillquist J
        • Larsson L
        • Lundstrom B
        Complications to subtotal parathyroidectomy.
        Acta Chir Scand. 1981; 147: 109-113
        • Edis AJ
        • Beahrs OH
        • vanHeerden JA
        • Akwari OE
        Conservative versus liberal approach to parathyroid neck exploration.
        Surgery. 1977; 82: 466-473
        • Lloyd HM
        Primary hyperparathyroidism: an analysis of the role of the parathyroid tumor.
        Medicine (Baltimore). 1968; 47: 53-71
        • Mallette LE
        • Bilezikian JP
        • Heath DA
        • Aurbach GD
        Primary hyperparathyroidism: clinical and biochemical features.
        Medicine (Baltimore). 1974; 53: 127-146
        • Parsons JA
        Parathyroid physiology and the skeleton.
        in: The biochemistry and physiology of bone. vol 4. Academic Press, New York1977: 159-225
        • Zamboni WA
        • Folse R
        Adenoma weight: a predictor of transient hypocalcemia after parathyroidectomy.
        Am J Surg. 1986; 152: 611-615
        • Epstein F
        Calcium and the kidney.
        Am J Med. 1968; 45: 700-714
        • Parfitt AM
        The coupling of bone formation to bone resorption: a critical analysis of the concept and of its relevance to the pathogenesis of osteoporosis.
        Metab Bone Dis Relat Res. 1982; 4: 1-6