Hungry Bone Syndrome (HBS) in Patients Operated for Primary Hyperparathyroidism (PHPT): A Six-Year Experience
DOI:
https://doi.org/10.32412/pjohns.v32i2.59Keywords:
hungry bone syndrome, Philippines, primary hyperparathyroidismAbstract
Objective: To review cases of adult patients who develop Hungry Bone Syndrome (HBS) after parathyroidectomy for Primary Hyperparathyroidism (PHPT) in a tertiary care center in the Philippines and describe the clinical features, pre-operative preventive measures done, and risk factors for HBS.
Methods: Study Design: Retrospective case note review Setting: Tertiary Private Hospital Participants: Chart review of adult Filipino patients who underwent parathyroidectomy for PHPT at Makati Medical Center from January 2011 to December 2016 was conducted and evaluated according to the inclusion and exclusion criteria. Medical information obtained included clinical parameters, biochemical results, operation performed, pathology, length of hospital stay and complications if with any.Results: From among 20 adult Filipino patients (mean age 55 years; 13, 65% female) who underwent parathyroidectomy for PHPT, HBS was found in 7 (35%). Most common pre-operative symptoms of hypercalcemia were musculoskeletal complaints. To prevent HBS, all were hydrated prior to surgery, while some were given bisphosphonates and diuretics. The most common parathyroid gland imaging used for pre-procedure localization was Tc 99m Sestamibi scan with single photon emission computed tomography (SPECT) and 19 (95%) had parathyroid adenoma on post-operative histopathologic report. Among biochemical and clinical factors that may be risk factors for HBS, those with HBS had significantly lower pre-operative 25-hydroxyvitamin D, higher BUN, phosphate and alkaline phosphatase (ALP) than those without HBS. Of these, only ALP showed significant association with HBS (OR = 107.17, p = <0.0001). Length of hospital stay was longer among those with HBS, although not statistically significant.
Conclusion: Knowledge on post-parathyroidectomy HBS for PHPT may aid clinicians on pre-operative prevention and post-operative monitoring. Thirty-five percent (7) of our patients presented with HBS post-parathyroidectomy for PHPT from 2011 to 2016. An abnormal ALP level pre-operatively may be a risk factor in developing HBS post-parathyroidectomy for PHPT.
Keywords: primary hyperparathyroidism, hungry bone syndrome, Philippines
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Copyright transfer (all authors; where the work is not protected by a copyright act e.g. US federal employment at the time of manuscript preparation, and there is no copyright of which ownership can be transferred, a separate statement is hereby submitted by each concerned author). In consideration of the action taken by the Philippine Journal of Otolaryngology Head and Neck Surgery in reviewing and editing this manuscript, I hereby assign, transfer and convey all rights, title and interest in the work, including copyright ownership, to the Philippine Society of Otolaryngology Head and Neck Surgery, Inc. (PSOHNS) in the event that this work is published by the PSOHNS. In making this assignment of ownership, I understand that all accepted manuscripts become the permanent property of the PSOHNS and may not be published elsewhere without written permission from the PSOHNS unless shared under the terms of a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license.
