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Background <p>Hungry bone syndrome (HBS) is a complication after parathyroidectomy (PTX) for primary hyperparathyroidism (PHPT), with variable prevalence worldwide. Data on predictors and outcomes are limited. This study assessed the prevalence, risk factors, and outcomes of HBS after PTX for PHPT.</p> Methods <p>A retrospective review of patients undergoing PTX for PHPT (2003–2023) at Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, South Africa. HBS was defined as hypocalcaemia (corrected serum calcium &lt; 2.1 mmol/l) lasting &gt; 4 days post-PTX with normal or elevated intact parathyroid hormone (iPTH). Clinical, biochemical, radiological data and hospital stay were recorded.</p> Results <p>Of 117 patients (86.4% female; 71,8% symptomatic) included in this analysis, HBS developed in 20.4% (n:24). Compared with the no-HBS group (<i>n</i> = 93), HBS patients were younger, leaner, and more likely to have osteoporosis or osteitis fibrosa cystica (OFC). They had higher preoperative iPTH (162.8 [104–208.7] vs. 23.1 [15.6–37.5] pmol/L, <i>P</i> &lt; 0.001) and ALP (696 [308.5–1323.5] vs. 111.5 [88.0–134.2] U/L, <i>P</i> &lt; 0.0001), with lower 25-OH vitamin D. Hospital stay was longer (19.5 [11.0–31.2] vs. 4.0 [3.0–4.0] days, <i>P</i> &lt; 0.0001). ROC analysis identified iPTH &gt; 121 pmol/L (Sn 73.9%, Sp 100%) and ALP &gt; 302 IU/L (Sn 78.3%, Sp 98.9%) as cut-points for HBS. In multivariate analysis, independent predictors were OFC (OR 7.7, 95%CI 1.5–40.6; <i>P</i> = 0.016) and iPTH &gt; 121 pmol/L (OR 100.5, 95%CI 4.6–2225.8; <i>P</i> = 0.004).</p> Conclusion <p>HBS remains a relevant postoperative complication in PHPT, particularly in patients with advanced skeletal disease. Elevated preoperative iPTH levels and OFC may serve as useful markers for risk stratification. These indicators can assist in guiding perioperative management and optimising patient care. HBS prolonged the hospital stay, highlighting its clinical significance and implications for healthcare resource utilisation. Early identification of high-risk patients is therefore crucial to inform perioperative strategies and improve surgical outcomes.</p> Clinical trial number <p>Not applicable.</p>

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Postoperative hungry bone syndrome in primary hyperparathyroidism: risk factors and outcomes at a South African tertiary centre

  • 期刊论文

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  • 发表日期：

    2025年12月26日

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  • Imran M. Paruk,
  • Kamal Govind,
  • Fraser J. Pirie,
  • Ayesha A. Motala

摘要

Background

Hungry bone syndrome (HBS) is a complication after parathyroidectomy (PTX) for primary hyperparathyroidism (PHPT), with variable prevalence worldwide. Data on predictors and outcomes are limited. This study assessed the prevalence, risk factors, and outcomes of HBS after PTX for PHPT.

Methods

A retrospective review of patients undergoing PTX for PHPT (2003–2023) at Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, South Africa. HBS was defined as hypocalcaemia (corrected serum calcium < 2.1 mmol/l) lasting > 4 days post-PTX with normal or elevated intact parathyroid hormone (iPTH). Clinical, biochemical, radiological data and hospital stay were recorded.

Results

Of 117 patients (86.4% female; 71,8% symptomatic) included in this analysis, HBS developed in 20.4% (n:24). Compared with the no-HBS group (n = 93), HBS patients were younger, leaner, and more likely to have osteoporosis or osteitis fibrosa cystica (OFC). They had higher preoperative iPTH (162.8 [104–208.7] vs. 23.1 [15.6–37.5] pmol/L, P < 0.001) and ALP (696 [308.5–1323.5] vs. 111.5 [88.0–134.2] U/L, P < 0.0001), with lower 25-OH vitamin D. Hospital stay was longer (19.5 [11.0–31.2] vs. 4.0 [3.0–4.0] days, P < 0.0001). ROC analysis identified iPTH > 121 pmol/L (Sn 73.9%, Sp 100%) and ALP > 302 IU/L (Sn 78.3%, Sp 98.9%) as cut-points for HBS. In multivariate analysis, independent predictors were OFC (OR 7.7, 95%CI 1.5–40.6; P = 0.016) and iPTH > 121 pmol/L (OR 100.5, 95%CI 4.6–2225.8; P = 0.004).

Conclusion

HBS remains a relevant postoperative complication in PHPT, particularly in patients with advanced skeletal disease. Elevated preoperative iPTH levels and OFC may serve as useful markers for risk stratification. These indicators can assist in guiding perioperative management and optimising patient care. HBS prolonged the hospital stay, highlighting its clinical significance and implications for healthcare resource utilisation. Early identification of high-risk patients is therefore crucial to inform perioperative strategies and improve surgical outcomes.

Clinical trial number

Not applicable.