Department of Endocrinology, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal.
Department of Surgery, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal.
Endocr Regul. 2021 Jan 29;55(1):30-41. doi: 10.2478/enr-2021-0005.
Hungry bone syndrome (HBS) is a severe and underdiagnosed complication of parathyroidectomy in the treatment of primary hyperparathyroidism (PHP) and secondary hyper-parathyroidism to chronic kidney disease (SHP-CKD). A longitudinal study was conducted to compare the postoperative outcomes of patients who developed HBS in two different time frames: before and after implementing a protocol with an intensive electrolytic monitoring and an algorithm regarding electrolytic supplementation. Overall, 77 parathyroidectomies were included. In PHP, a protocol implementation led to an increased admission of patients in the Intermediate Care Unit for intensive electrolytic monitoring (p<0.001) and an increased rate of oral calcium replacement during hospital stay (p=0.013) compared to pre-protocol era. In SHP-CKD, duration of intravenous calcium replacement was reduced (p=0.010). The prevalence of HBS (9.8% in PHP and 58.3% in SHP-CKD) was similar between the two periods, although its diagnosis had an increased trend in PHP since the protocol implementation. None of the diagnosis of HBS was established due to hypocalcemic symptoms in the post-protocol era (contrary to pre-protocol period, p=0.021). Both hypocalcemia length and duration of surgical ward hospitalization were reduced (p=0.047 and p=0.042, respectively). An improved assessment of hyperparathyroidism and a decrease in HBS severity were noted in the post-protocol era. We strongly recommend the implementation of a standardized protocol with an intensive phosphocalcium monitoring in the high-risk patients who undergo parathyroidectomy due to hyperparathyroidism as it improves the health care and management of HBS.
饥饿骨综合征（HBS）是甲状旁腺切除术治疗原发性甲状旁腺功能亢进症（PHP）和继发性甲状旁腺功能亢进症至慢性肾脏病（SHP-CKD）的一种严重且诊断不足的并发症。进行了一项纵向研究，比较了在实施具有强化电解质监测和电解质补充算法的方案前后两个不同时间段发生 HBS 的患者的术后结果。总体而言，共纳入了 77 例甲状旁腺切除术。在 PHP 中，与方案实施前相比，方案实施后，因强化电解质监测而住院的患者更多（p<0.001），住院期间口服钙替代的比例更高（p=0.013）。在 SHP-CKD 中，静脉钙替代的持续时间缩短（p=0.010）。HBS 的患病率（PHP 为 9.8%，SHP-CKD 为 58.3%）在两个时期相似，尽管自方案实施以来，PHP 中 HBS 的诊断呈上升趋势。在后方案时代，由于低钙血症症状，没有建立 HBS 的诊断（与前方案时期相反，p=0.021）。在后方案时代，低钙血症的持续时间和外科病房住院时间均缩短（p=0.047 和 p=0.042）。在后方案时代，甲状旁腺功能亢进的评估得到改善，HBS 的严重程度降低。我们强烈建议在高危甲状旁腺功能亢进患者中实施具有强化磷钙监测的标准化方案，因为这可以改善 HBS 的医疗保健和管理。
