Altun Eda, Paydas Saime, Kaya Bulent, Balal Mustafa
Department of Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey.
Saudi J Kidney Dis Transpl. 2015 Sep;26(5):976-9. doi: 10.4103/1319-2442.164582.
Secondary hyperparathyroidism (SHPT) is a common problem in patients with end-stage renal disease. In cases with severe and resistant SHPT, surgical parathyroidectomy (PTX) is recommended. Hungry bone syndrome (HBS) following surgical PTX is most often associated with hypocalcemia and hypophosphatemia. The mechanisms for the HBS are not clear, and a method for its prevention has not been established. We present three hemodialysis patients with persistant hypophosphatemia after PTX. In our parathyroidectomized patients, hypocalcemia could be corrected with calcium and vitamin D treatment, but hypophosphatemia continued for eight months in one patient and in two other patients until the last visit (10 and 2 months, respectively). Predisposing factors such as old age, diabetes mellitus and parathyroid adenoma were not found in our patients. All three patients were younger (<35 years old) and anuric. Hemodialysis durations were seven, three and two years. In summary, HBS presented with hypocalcemia, and especially hypophosphatemia cannot be developed uncommonly and may persist for a long time following PTX in HD patients.
继发性甲状旁腺功能亢进（SHPT）是终末期肾病患者的常见问题。对于严重且难治性SHPT病例，建议进行甲状旁腺切除术（PTX）。PTX术后的饥饿骨综合征（HBS）最常与低钙血症和低磷血症相关。HBS的发病机制尚不清楚，且尚未确立预防方法。我们报告了3例PTX术后持续存在低磷血症的血液透析患者。在我们接受甲状旁腺切除术的患者中，低钙血症可用钙剂和维生素D治疗纠正，但1例患者的低磷血症持续了8个月，另外2例患者直至最后一次就诊时仍持续存在（分别为10个月和2个月）。我们的患者未发现诸如老年、糖尿病和甲状旁腺腺瘤等易感因素。所有3例患者均较年轻（<35岁）且无尿。血液透析时间分别为7年、3年和2年。总之，HBS表现为低钙血症，尤其是低磷血症在HD患者PTX后并非不常见，且可能会持续很长时间。
