Hungry bone syndrome: A rare complication post parathyroidectomy
Dr. Dharmik Patel
, Dr. JG Bhatt , Dr. JG Vagadiya , Dr. Swapnil Tolia
Hungry bone syndrome (HBS), rarely named “bone starvation syndrome”, severe hypocalcemia following parathyroidectomy (PTX) due to rapid drop of PTH after a previous long term elevated concentration and associated bone remineralisation, impairs the outcome of underlying parathyroid (PT) disease by affecting the quality of life, prolonged hospitalisation stay, and increased post-operatory re-admission rate. HBS prevalence widely varies according to studied population, 15–25% to 92% of patients diagnosed with renal hyperparathyroidism (RHPT), in cases with primary hyperparathyroidism (PHPT), might not be identified at all, but overall prevalence accounts for up to 15–20% of individuals with PHPT; generally, a more important risk of developing HBS is registered in participants with impaired renal function. Hypocalcemia (usually below the value of 8.2–8.4 mg/dL), a typically severe and even life-threatening unless prompt intervention, arises within the third (varying between the first/second and the fourth–seventh) post-operatory day and it usually progresses through a 3-day period of time up to 30 days, requiring intravenous calcium replacement. Associated hypophosphatemia, hypomagnesiemia, and, exceptionally, hyperkaliemia (in patients undergoing chronic dialysis) are identified. This severe, but transitory, event is followed by mild or asymptomatic hypocalcemia requiring oral calcium and vitamin D substitution, particularly calcitriol, which may take a few months up to a year in order to register the restauration of normal mineral metabolism without the help of any medication. Early after PT surgery, normal or high (but lower than pre-operatory level) parathyroid hormone (PTH) is essential for establishing HBS diagnostic since non-low PTH is the clue to differentiate the condition from post-surgery hypoparathyroidism (low PTH). Pre-operatory assessments that might be a clue for further developing HBS after Parathyroid surgery vary; the most common are extremely high serum PTH and bone formation marker alkaline phosphatase (AP), noting that HBS involves an increased osteoblastic activity in association with a normal or low osteoclastic activity. Correction of hypercalcemia and starting calcium replacement from the first day of PTx might improve the outcome of HBS.
"Hungry bone syndrome: A rare complication post parathyroidectomy", IJSDR - International Journal of Scientific Development and Research (www.IJSDR.org), ISSN:2455-2631, Vol.9, Issue 11, page no.319 - 324, November-2024, Available :https://ijsdr.org/papers/IJSDR2411041.pdf
Volume 9
Issue 11,
November-2024
Pages : 319 - 324
Paper Reg. ID: IJSDR_212688
Published Paper Id: IJSDR2411041
Downloads: 000346998
Research Area: Medical Science
Country: Rajkot, Gujarat , India
ISSN: 2455-2631 | IMPACT FACTOR: 9.15 Calculated By Google Scholar | ESTD YEAR: 2016
An International Scholarly Open Access Journal, Peer-Reviewed, Refereed Journal Impact Factor 9.15 Calculate by Google Scholar and Semantic Scholar | AI-Powered Research Tool, Multidisciplinary, Monthly, Multilanguage Journal Indexing in All Major Database & Metadata, Citation Generator
Publisher: IJSDR(IJ Publication) Janvi Wave
