The Effect of Preoperative Biochemical Parameters on the Development of Hungry Bone Syndrome After Surgery for Primary Hyperparathyroidism

Background

Hungry bone syndrome (HBS) characterised by prolonged hypocalcemia, occurs commonly following parathyroidectomy in patients with primary hyperparathyroidism (PHPT). Although this complication is common, research in this field is very scarce. This study aimed to determine the incidence, characteristics of patients with HBS, and the effect of preoperative biochemical parameters on HBS.

Methods

In this retrospective study we enroled 144 patients with PHPT who underwent successful parathyroidectomy from January 2010 to January 2020. Preoperative and postoperative laboratory parameters were assessed. Logistic regression analysis was used to identify factors affecting the incidence of HBS.

Results

One hundred six patients (73.6%) were women and the female-to-male ratio was 2.8−1. The median (IQR) age of all patients was 54 (19) years. HBS developed in 25 (17.36%) patients (5 men and 20 women, p = 0.425). Total calcium and parathyroid hormone preoperatively were significantly higher in patients with HBS, while serum phosphorus and magnesium levels did not differ statistically between the two groups. The resected parathyroid gland volume was higher in those with HBS compared to those without. Postoperatively, patients with HBS had longer hospital stays and lower serum phosphorus levels. However, these variables could not predict the occurrence of HBS after surgery in the performed regression model.

Conclusion

The patients with HBS had higher levels of calcium and parathyroid hormone preoperatively, along with larger resected parathyroid glands. Nevertheless, preoperative parameters were unable to predict HBS. Therefore, biochemical monitoring after surgery seems necessary to detect HBS and protect patients from severe hypocalcemia.