Vitamin D Deficiency is a Risk Factor for Hungry Bone Syndrome after Surgery for Primary Hyperparathyroidism
Author: Borissova, Anna-Maria I., Vlahov, Jordan D.
Sofia University “Sv. Kliment Ohridski”
Abstract: In patients with primary hyperparathyroidism (PHPT) after parathyroidectomy, the serum calcium levels (sCa) decline rapidly after successful removal of one or more parathyroid glands. Hungry Bone Syndrome (HBS) is an onset of rapid, deep (sCa <2,1 mmol/L) and prolonged (>4 days postoperatively) hypocalcaemia, accompanied by hypophosphataemia and hypomagnesaemia. The condition is observed in a sharp decrease in parathyroid hormone (PTH) level after parathyroidectomy, provided that there is severe PHPT and very high bone turnover preopetatively. Among the risk factors can be advanced age, adenoma size at PHPT, bone involvement in the general clinic, and vitamin D deficiency. The only factor that can be influenced is vitamin D deficiency.
Conclusion: The usual 25(OH)D deficiency for primary hyperparathyroidism should be corrected in order to:
1. Reduction of PTH and its negative effects;
2. Preparation of patients for the upcoming surgical treatment, when the flow of calcium from the bone will drop sharply after the sharp decrease in PTH. This will prevent post-operative “hungry bone” syndrome;
3. Rapid replacement with high doses of calcium and active metabolites of vitamin D during the period of high bone turnover to decrease and bring it to a lower normal level.
Key words: primary hyperparathyroidism, vitamin D deficiency, parathyroidectomy, “hungry bone” syndrome
