Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Endocr Pract. 2024 Nov;30(11):1079-1088. doi: 10.1016/j.eprac.2024.08.004. Epub 2024 Aug 29.
Hungry bone syndrome (HBS) is a common complication after parathyroidectomy in dialysis patients with severe secondary hyperparathyroidism. The rapid decline in parathyroid hormone (PTH) levels diminishes bone resorption and accelerates bone formation. This causes a significant influx of calcium and phosphate into the bone, resulting in severe and prolonged hypocalcemia. While previous studies have established risk factors for HBS, the outcomes beyond the reduced recurrence rate of hyperparathyroidism have been largely unexplored.
This single-center retrospective study analyzed 322 cases in 314 dialysis patients who underwent parathyroidectomy between 2012 and 2022. The study examined baseline factors associated with HBS, adverse events, and clinical outcomes, including changes in blood pressure and hematologic and nutritional parameters over 3-12 months of follow-up, stratified by HBS status.
Total parathyroidectomy was performed in 28 cases (8.7%), total parathyroidectomy with implantation in 98 cases (30.4%), and subtotal parathyroidectomy in 196 cases (60.9%). HBS occurred in 207 cases (64%). Independent predictors of HBS included male sex, lower serum calcium levels, higher PTH levels, and lack of active vitamin D treatment at baseline. Patients with HBS had longer hospital stays but did not experience an increase in other adverse events. Following parathyroidectomy, the HBS group showed a greater reduction in blood pressure and more significant increases in hemoglobin, total lymphocyte count, and serum creatinine. This group also saw a more substantial decrease in the proportions of patients with hemoglobin <11 g/dL and serum creatinine/body surface area <380 μmol/L/m. Although the HBS group showed a more significant decline in PTH levels from baseline, similar proportions achieved the target PTH level by the end of the study. Serum calcium levels remained substantially lower in the HBS group throughout the follow-up, while serum phosphate and PTH levels were comparable.
HBS was associated with more pronounced improvements in blood pressure, anemia, and nutritional parameters. The presence of HBS could indicate greater achievement in controlling hyperparathyroidism following parathyroidectomy.
饥饿骨综合征（HBS）是接受甲状旁腺切除术的透析患者伴严重继发性甲状旁腺功能亢进的常见并发症。甲状旁腺激素（PTH）水平的快速下降会减弱骨质吸收并加速骨质形成。这会导致大量钙和磷酸盐涌入骨骼，从而导致严重且持续的低钙血症。尽管先前的研究已经确定了 HBS 的风险因素，但除了甲状旁腺功能亢进复发率降低之外，其结果在很大程度上仍未得到探索。
本单中心回顾性研究分析了 2012 年至 2022 年间接受甲状旁腺切除术的 314 例透析患者中的 322 例。该研究检查了与 HBS 相关的基线因素、不良事件和临床结果，包括在 3-12 个月的随访期间，根据 HBS 状态，血压和血液学及营养参数的变化。
行全甲状腺切除术 28 例（8.7%），甲状旁腺全切加植入术 98 例（30.4%），甲状旁腺次全切除术 196 例（60.9%）。HBS 发生于 207 例（64%）。HBS 的独立预测因素包括男性、血清钙水平较低、PTH 水平较高和基线时缺乏活性维生素 D 治疗。HBS 患者的住院时间更长，但没有发生其他不良事件的增加。甲状旁腺切除术后，HBS 组的血压下降更为显著，血红蛋白、总淋巴细胞计数和血清肌酐增加更为显著。该组中血红蛋白<11 g/dL 和血清肌酐/体表面积<380 μmol/L/m 的患者比例也显著降低。尽管 HBS 组的 PTH 水平从基线显著下降，但到研究结束时，达到目标 PTH 水平的比例相似。在整个随访期间，HBS 组的血清钙水平仍然明显较低，而血清磷酸盐和 PTH 水平相似。
HBS 与血压、贫血和营养参数的显著改善相关。HBS 的存在可能表明甲状旁腺切除术后甲状旁腺功能亢进的控制效果更好。
