Kaderli Reto Martin, Riss Philipp, Dunkler Daniela, Pietschmann Peter, Selberherr Andreas, Scheuba Christian, Niederle Bruno
Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Eur J Endocrinol. 2018 Jan;178(1):1-9. doi: 10.1530/EJE-17-0416. Epub 2017 Sep 6.
Prolonged hypocalcemia but normal intact parathyroid hormone (iPTH) levels after surgery for primary hyperparathyroidism (PHPT) are referred to as 'hungry bone syndrome' (HBS). The aim was to evaluate preoperative risk factors for HBS with a focus on the impact of 25-hydroxyvitamin D (25(OH)D) deficiency.
Patients having undergone initial successful surgery for sporadic PHPT within 6 years were considered for retrospective analysis.
A total of 385 patients were evaluated, of whom 33 (8.6%) developed HBS influencing negatively the postoperative bone metabolism. All patients underwent biochemical evaluations two days before parathyroid surgery and were followed biochemically on a daily basis in the first postoperative week and thereafter at 8 weeks and 6 months.
No relationship was established between preoperative 25(OH)D deficiency and HBS. The only significant risk factor for HBS in multivariable analysis was high levels of preoperative iPTH. As HBS therefore cannot be predicted preoperatively, we recommend a consistent postoperative calcium and vitamin D supplementation to improve the bone metabolism.
原发性甲状旁腺功能亢进症（PHPT）手术后出现持续性低钙血症但甲状旁腺激素（iPTH）水平正常的情况被称为“饥饿骨综合征”（HBS）。本研究旨在评估HBS的术前危险因素，重点关注25-羟维生素D（25(OH)D）缺乏的影响。
对6年内首次成功进行散发性PHPT手术的患者进行回顾性分析。
共评估了385例患者，其中33例（8.6%）发生HBS，对术后骨代谢产生了负面影响。所有患者在甲状旁腺手术前两天进行生化评估，并在术后第一周每天进行生化随访，此后在8周和6个月时再次随访。
术前25(OH)D缺乏与HBS之间未建立关联。多变量分析中HBS唯一显著的危险因素是术前iPTH水平高。由于因此无法术前预测HBS，我们建议术后持续补充钙和维生素D以改善骨代谢。
