Síndrome de hueso hambriento en pacientes con paratiroidectomía

Introducción: El síndrome de hueso hambriento (SHH) es una complicación asociada a la realización de una paratiroidectomía, definido por la persistencia de más de 4 días de hipocalcemia (Calcio sérico menor a 8,5 mg/dl) con requerimiento de suplementación de calcio endovenoso. Este es el primer estudio realizado en Colombia, que tiene el objetivo de precisar la prevalencia de SHH en un Hospital de referencia en Latinoamérica. Metodología: Se realizó un estudio de corte transversal retrospectivo, se revisaron los registros de historias clínicas de pacientes con antecedente de hiperparatiroidismo primario, secundario y terciario que requirieron paratiroidectomía parcial o total en el Hospital de San José de Bogotá, entre Enero del 2013 y Diciembre de 2021. Resultados: Se identificaron 247 pacientes con diagnóstico de hiperparatiroidismo, la mayoría de los pacientes (65,1%) fueron hombres, con una edad mediana de 50,9 años (rango de 25 a 71 años). La prevalencia del SHH fue del 11,7%, con una relación mujer-hombre de 1.5:1, no hubo casos de patología maligna. Los niveles de hormona paratiroidea séricos preoperatorios tuvieron una correlación estadísticamente significativa con los niveles de hormona paratiroidea postquirúrgica. Conclusiones: El síndrome de hueso hambriento es una complicación que puede presentarse posterior a la realización de una paratiroidectomía. Este estudio presenta una prevalencia más baja que la descrita en la literatura.

Introduction: The Hungry Bone Syndrome (HBS) is a rare complication associated with parathyroidectomy, defined as hypocalcemia (serum calcium less than 8,5 mg/dl) that persist more than 4 days and requires intravenous calcium supplementation. This is the first study made in Colombia with the objective to determine the prevalence of HBS in a reference hospital in Latin America. Methods: A retrospective cross-sectional study was conducted; medical records were reviewed from patients with medical history of primary, secondary, and tertiary hyperparathyroidism that require partial or total parathyroidectomy in San Jose Hospital in Bogota, between January 2013 and December 2021. Results: 247 patients were identified with hyperparathyroidism, most patients were males (65.1%), with a mean age of 50.9 years old (range 25-71 years old). The prevalence of HBS was 11.7%, with a ratio women-men 1.5:1, no malignant pathology was described. Preoperative parathyroid hormone levels and postoperative parathyroid hormone levels were statistically significant. Conclusions: The Hungry Bone Syndrome is a complication that can be present after a parathyroidectomy. This study presents a lower prevalence than the literature described.

Hypercalcium crisis and postoperative hungry bone syndrome caused by primary hyperparathyroidism: a case report / 临床耳鼻咽喉头颈外科杂志

To review the diagnosis and treatment of a case of hypercalcium crisis caused by primary hyperparathyroidism（PHPT） and prophylactic treatment of hungry bone syndrome. In a 32-year-old male with hypercalcemia, the main manifestations were loss of appetite, nausea, polyuria, polydipsia, fatigue, lethargy, etc. parathyroid hormone, serum calcium increased, thyroid function was normal, thyroid color ultrasound and MRI showed space-occupying behind the right thyroid, radionuclide examination showed abnormal imaging agent concentration in the right parathyroid area, there was a history of pathological fracture. Clinically diagnosed as hypercalcemia crisis secondary to PHPT.

Risk factors for hypocalcemia after parathyroidectomy in maintenance hemodialysis patients with secondary hyperparathyroidism / 中华肾脏病杂志

Objective:To explore the risk factors of hypocalcemia and the correlation between calcium supplementation and clinical parameters after parathyroidectomy (PTX) in maintenance hemodialysis patients with secondary hyperparathyroidism (SHPT), and to analyze the effect of calcium supplementation after PTX on the long-term prognosis of patients.Methods:This study was a single-center retrospective study. The patients who underwent PTX in maintenance hemodialysis patients with SHPT in the Huashan Hospital affiliated to Fudan University from October 2014 to March 2021 were retrospectively enrolled. Total PTX with auto transplantation or total PTX alone were the surgical procedures. According to the postoperative requirement of calcium in the first week, the patients were divided into two groups: high calcium supplement (>16.05 g/week) group and low calcium supplement group (≤16.05 g/week). According to the average serum calcium level in the first week after operation, the patients were divided into hypocalcemia group (≤2.1 mmol/L) and non-hypocalcemia group (>2.1 mmol/L) and the differences of clinical parameters between the two groups were compared. The correlation between clinical parameters and the postoperative calcium requirement was examined through Pearson or Spearman correlation analysis. The influencing factors for hypocalcemia after PTX were examined through logistic regression analysis. The survival curve was made by Kaplan-Meier method, and the difference of cumulative survival rate between the two groups was compared by log-rank test.Results:A total of 98 maintenance hemodialysis patients with SHPT were enrolled. The levels of serum calcium, phosphorus, and intact parathyroid hormone (iPTH) after the operation decreased significantly than those of preoperation (all P<0.05). Multiple linear regression analysis showed age ( β=-0.160, P=0.030), iPTH ( β=0.004, P=0.025) and C-reactive protein ( β=0.186, P=0.011) were correlated with postoperative calcium requirement. Preoperative alkaline phosphatase ( OR=1.002, 95% CI 1.000-1.004, P=0.018) and hemoglobin ( OR=0.977, 95% CI 0.954-1.000, P=0.048) independently predicted the occurrence risk of postoperative hypocalcemia through multivariate logistic regression analysis. The recurrence rate of high calcium supplement group was higher than that of low calcium supplement group (10.26% vs 0, P=0.023) and there was no significant difference in all-cause mortality between the two groups (17.95% vs 5.08%, P=0.086). The recurrence rate between the hypocalcemia group and non-hypocalcemia group was no significantly different (8.3% vs 1.8%, P=0.451) and there was no significant difference in all cause mortality between the two groups (12.5% vs 12.7%, P=1.000). Kaplan-Meier survival curve showed that the cumulative survival rate between the two groups was no significantly different (log-rank test χ2=0.147, P=0.702). Conclusions:PTX is a safe and effective therapeutic method to reduce the level of iPTH and improve the metabolism of calcium and phosphorus in SHPT patients. Age, iPTH and C-reactive protein are correlated with the postoperative requirement of calcium in the first week. Preoperative alkaline phosphatase and hemoglobin are independent risk factors for postoperative hypocalcemia. Correcting preoperative electrolyte disorder, improving infection and anemia can reduce the incidence of hypocalcemia after PTX.

Strengthening the prevention and treatment of hungry bone syndrome, parathyroid hyperfunction and hyperparathyroidism of thyroid cancer patients after thyroidectomy / 中华内分泌外科杂志

Differentiated thyroid cancer is one of the most common endocrine malignant tumors, and thyroidectomy is its basic treatment measures. Insufficient attention is paid to its postoperative bone hungry syndrome and parathyroid hyperfunction or hyperparathyroidism, which will seriously affect the patient’s life quality and prognosis. This paper will explore the etiology, dangers, diagnosis, prevention, and treatment for hungry bone syndrome, parathyroid hyperfunction and hyperparathyroidism of thyroid cancer patients after thyroidectomy.

Pre-operative Tc-99m sestamibi parathyroid scan and bone scintigraphy in a case of synchronous parathyroid carcinoma and papillary microcarcinoma

Background@#Parathyroid carcinoma is an uncommon, aggressive, endocrine malignant neoplasm and subsequent parathyroidectomy of such cases may lead to the life-threatening hypocalcemic condition called Hungry Bone Syndrome. We present a very rare case of parathyroid carcinoma with concomitant thyroid microcarcinoma with Hungry Bone Syndrome as its sequalae.@*Case Presentation@#A 54/F initially presenting with hypogastric pain was showed to have nephrolithiasis. Subsequent Endocrinology referral revealed hypercalcemia and osteoporosis – and with a working impression of hypercalcemia secondary to a parathyroid adenoma. Sestamibi parathyroid scan showed persistently avid uptake in the left thyroid lobe highly suspicious for a parathyroid adenoma, but a concomitant thyroid nodule was not ruled out. Bone scan showed intense and diffuse tracer uptake in the skull and irregular tracer activity in the ribs, suggestive of metabolic bone disease, with no evidence of metastatic-looking bone lesions. She underwent left thyroid lobectomy with isthmusectomy and Sestamibi-guided left parathyroidectomy. Histopathology report showed a parathyroid gland carcinoma with papillary thyroid microcarcinoma. Two weeks post-surgery, hypocalcemic signs developed and ionized calcium was low. Hungry Bone Syndrome was considered and was treated with calcium gluconate and Zoledronic acid.@*Conclusion@#Nuclear imaging techniques and radioguided surgery are helpful in the diagnosis and management of both parathyroid and thyroid lesions – especially in difficult cases.

Para superar el flagelo del hambre: una integracion regional basada en la soberania alimentaria / Para superar o flagelo da fome: uma integração regional baseada na soberania alimentar / To overcome the flagel of hunger: a regional integration based on food sovereignty

El artículo aborda el problema del hambre en el mundo, uno de los fenómenos más aberrantes con que la humanidad inició la nueva década. A partir del año 2014 comenzó a manifestarse una tendencia ascendente en la inseguridad alimentaria hasta alcanzar niveles graves en 2019-2020. Con el inicio de la pandemia de COVID-19, se ha acentuado la preocupación respecto a los efectos que ésta podría provocar en la crisis alimentaria a nivel mundial y, espe-cialmente, en América Latina y el Caribe, debido a que es el continente donde el acceso mercantil a la alimentación se sitúa entre las más costosas del mundo. Por cierto, la región no enfrenta escasez de alimentos, sino que al contrario hay abundancia de ellos. Estas contradicciones hacen necesario cuestionarse si la liberalización del mercado ha sido una solución para resolver el problema del hambre a nivel mundial. Así como también, revisar la pertinencia de las políticas "oficiales" de seguridad alimentaria y de sus instituciones impulsoras. Una de las vías de solución es lograr la acción coordinada y permanente de los Estados para garantizar la provisión de alimentos a la población y evitar el avance del hambre. Hoy más que nunca se requiere el fortalecimiento de proyectos de integración regional basados en la soberanía alimentaria.

O artigo aborda o problema da fome no mundo, um dos fenômenos mais aberrantes com que a humanidade começou a nova década. A partir de 2014, começou a se manifestar uma tendência crescente na insegurança alimentar, alcançando graves níveis em 2019-2020. Com o início da pandemia de COVID-19, se acentuou a preocupação a respeito dos efeitos que esta poderia provocar na crise alimentícia a nível mundial e especialmente na América Latina e no Caribe, onde o acesso mercantil à alimentação é um dos mais caros do mundo. No entanto, a região não enfrenta escassez de alimentos, pelo contrário, possui uma grande abundância. Considerando estas contradições, faz-se necessário questionar se a liberação do mercado tem sido uma solução para resolver o problema da fome a nível mundial. Assim como revisar a pertinência das políticas "oficiais" de segurança alimentar e de suas instituições impulsionadoras. Uma das soluções seria obter a ação coordenada e permanente dos Estados a fim de garantir o fornecimento de alimentos à população e evitar o avanço da fome. Hoje, mais do que nunca, é preciso o fortalecimento de projetos de integração regional baseados na soberania alimentar

The article addresses the problem of hunger in the world, one of the most aberrant phenomena with which humanity began the new decade. Starting in 2014, an upward trend in food insecurity began to manifest itself, reaching serious levels in 2019-2020.With the onset of the COVID-19 pandemic, concern grew about the effects it could have on the food crisis worldwide and, especially in Latin America and the Caribbean. The latter, because it is the region where commercial access to food is among the most expensive in the world. By the way, Latin America does not face a shortage of food, but on the contrary it has an abundance of them. These contra-dictions make it necessary to question whether market liberalization has been a solution to solve the problem of hunger at the world level. As well as reviewing the relevance of "official" food security policies and their driving institutions. One of the solutions is to achieve coordinated and permanent action by the States to guarantee the provision of food to the population and prevent the advance of hunger. Our conclusion is that the strengthening of regional integration projects based on food sovereignty is required.

Influencing factors of hungry bone syndrome in maintenance hemodialysis patients after parathyroidectomy / 中华肾脏病杂志

Objective To investigate the influencing factors of hungry bone syndrome (HBS) in maintenance hemodialysis patients with secondary hyperparathyroidism (SHPT) after parathyroidectomy (PTX). Methods A retrospective study was conducted on maintenance hemodialysis patients with SHPT undergoing successful parathyroidectomy with autotransplantation. Clinical data and perioperative indicators of the selected patients were collected. The enrolled patients were divided into HBS group and non-HBS group based on whether the lowest level of blood calcium less than 2.0 mmol/L after surgery. The difference of general clinical data and perioperative indicators between the two groups were compared. The risk factors of HBS were analyzed by logistic regression analysis. Multiple linear regression method was used to analyze the independent factors affecting the maintenance time of intravenous calcium supplementation, the total amount of calcium supplementation during intravenous calcium supplementation and the highest serum level of potassium within 24 h after surgery. Results A total of 306 patients were included in the study. All patients had low levels of serum calcium after operation. There were 230 patients (75.16% ) with the lowest blood calcium＜2.00 mmol/L after PTX (HBS group), and 76(24.84%) cases in the non-HBS group. Predialysis coefficient of serum calcium=(preoperative blood calcium-2.20) mmol/L÷0.01 mmol/L. Logistic regression analysis showed that higher predialysis coefficient of serum calcium (B=-0.063, OR=0.939, 95% CI 0.894-0.987, P=0.013) and lower level of preoperative serum alkaline phosphatase (ALP) (B=0.035, OR=1.033, 95%CI 1.019-1.050, P＜0.001) were independent risk factors for HBS. Multiple linear regression analysis revealed that preoperative blood intact parathyroid hormone (iPTH) (B=0.017, P＜0.001 and B=0.041, P＜0.001), preoperative serum ALP (B=0.052, P＜0.001 and B=0.107, P＜0.001) and preoperative hemoglobin (Hb) (B=-0.453, P=0.041 and B=-1.058, P=0.007) were independent factors affecting the maintenance time of intravenous calcium supplementation and the total amount of calcium supplementation in HBS patients. Preoperative predialysis level of serum potassium (B=0.859, P＜0.001) was the independent influencing factor of the maximum level of serum potassium within 24 hours after surgery. Conclusions Patients with lower levels of preoperative serum calcium and higher levels of serum ALP are prone to HBS after PTX. Postoperative calcium supplementation may need to be strengthened in HBS patients with higher preoperative iPTH and ALP levels and lower preoperative Hb levels. High preoperative basal potassium levels may increase the risk of hyperkalemia after PTX.

Estudio e investigación del comportamiento alimentario: Raíces, desarrollo y retos / Study and research of feeding behavior: Roots, development and challenges

Resumen El presente trabajo expone una revisión de las raíces y el desarrollo del estudio e investigación sobre comportamiento alimentario (CA). Se destacan las aportaciones iniciales y algunas otras que le han venido dotando de identidad a esta área de estudio. Entre ellas, el señalamiento de la conducta como medio indispensable para mantener el estado de equilibrio en los organismos, y el papel del aprendizaje como determinante de la preferencia, la selección y el consumo de alimento. Posteriormente se presentan los argumentos que establecen al CA como elemento integrador del conocimiento que sobre alimentación han generado otras áreas de la ciencia. Finalmente se puntualizan los principales retos a enfrentar por parte de los académicos dedicados al estudio e investigación sobre CA, y se pondera el papel de la educación en alimentación y nutrición como la solución óptima a las problemáticas alimentarias.

Abstract The present work provides a review of the basis and development of the study and research on feeding behavior (FB). Initial contributions and those that gave identity to this field are highlighted. Among them, the behavior is approached as an essential mean to maintain the state of balance in the organisms, as well as the role of learning as a determinant of food preference, selection and consumption. Subsequently, are presented the arguments that establish FB as an element that integrate the knowledge related to feeding generated by other areas of science. Finally, are stated the main challenges for academics dedicated to the study and research of FB and the role of education on food and nutrition as an optimal solution for food problems.

Hypocalcemia development in patients operated for primary hyperparathyroidism: Can it be predicted preoperatively?

ABSTRACT Objective Primary hyperparathyroidism (PHP) is a common endocrine disease, and its most effective treatment is surgery. Postoperative hypocalcemia is a morbidity of parathyroid surgeries, and it may extend hospitalization durations. The purpose of this study is to determine the predictive factors related to the development of hypocalcemia and hungry bone syndrome (HBS) in patients who underwent parathyroidectomy for PHP. Materials and methods Laboratory data comprising parathyroid hormone (PTH), calcium, phosphate, 25-OHD, albumin, magnesium, alkaline phosphatase (ALP), blood urea nitrogen (BUN), and thyroid stimulating hormone (TSH) of the patients were recorded preoperatively, on the 1st and 4th days postoperatively, and in the 6th postoperative month, and their neck ultrasound (US) and bone densitometry data were also recorded. Results Hypocalcemia was seen in 63 patients (38.4%) on the 1st day after parathyroidectomy. Ten patients (6.1%) had permanent hypocalcemia in the 6th month after surgery. Out of the patients who underwent parathyroidectomy for PHP, 22 (13.4%) had HBS. The incidence of postoperative hypocalcemia was higher in patients who underwent parathyroidectomy for PHP, who had parathyroid hyperplasia, and who had osteoporosis. Preoperative PTH, ALP, and BUN values were higher in those patients who developed HBS. Furthermore, HBS was more common in patients who had osteoporosis, who had parathyroid hyperplasia, and who underwent thyroidectomy simultaneously with parathyroidectomy. Conclusions As a result, patients who have the risk factors for development of hypocalcemia and HBS should be monitored more attentively during the perioperative period.

Brown Tumor of the Patella Caused by Primary Hyperparathyroidism: A Case Report

It has been reported that the common sites of brown tumors are the jaw, pelvis, ribs, femurs and clavicles. We report our experience in a case of brown tumor of the patella caused by primary hyperparathyroidism. An initial radiograph and CT showed an osteolytic lesion and MR images showed a mixed solid and multiloculated cystic tumor in the right patella. One month after the parathyroidectomy, rapid bone formation was observed on both radiographs and CT images.

Hungry bone syndrome after parathyroidectomy of a minimally invasive parathyroid carcinoma / 대한외과학회지

The prognosis of parathyroid carcinoma varies significantly between numerous studies. Therefore, many attempts have been made to grade the degree of parathyroid carcinoma, and recently, classifying parathyroid carcinomas into either minimally invasive or widely invasive carcinoma- similar to follicular carcinoma of the thyroid- has led to a more reliable prediction of the prognosis. Hungry bone syndrome can occur if parathyroidectomy is performed due to primary hyperparathyroidism regardless of the cause of the disease. Hungry bone syndrome is characterized by postoperative a hypocalcemic state due to remineralization of various minerals, including calcium, of the bone; this syndrome requires a long-term supplementation of calcium. The authors aim to report, along with a review of related literatures, 1 case of a 29-year-old female patient diagnosed with minimally invasive parathyroid carcinoma who fell into hungry bone syndrome after parathyroidectomy.

Hungry bone syndrome after parathyroidectomy of a minimally invasive parathyroid carcinoma / 대한외과학회지

The prognosis of parathyroid carcinoma varies significantly between numerous studies. Therefore, many attempts have been made to grade the degree of parathyroid carcinoma, and recently, classifying parathyroid carcinomas into either minimally invasive or widely invasive carcinoma- similar to follicular carcinoma of the thyroid- has led to a more reliable prediction of the prognosis. Hungry bone syndrome can occur if parathyroidectomy is performed due to primary hyperparathyroidism regardless of the cause of the disease. Hungry bone syndrome is characterized by postoperative a hypocalcemic state due to remineralization of various minerals, including calcium, of the bone; this syndrome requires a long-term supplementation of calcium. The authors aim to report, along with a review of related literatures, 1 case of a 29-year-old female patient diagnosed with minimally invasive parathyroid carcinoma who fell into hungry bone syndrome after parathyroidectomy.

Effect of Estrogen on Osteoblast Apoptosis Induced by Serum Hungry / 中国康复理论与实践

@#ObjectiveTo explore the effect of estrogen on osteoblast apoptosis induced by serum hungry in vitro.MethodsOsteoblasts of second or third generation from newly born SD rats calvaria were divided randomly into the control group, serum hungry group and serum hungry with estrogen group. Cells of each group were incubated for 24 h, 48 h, 72 h, 5 d, 7 d and 14 d, then labeled using TUNEL staining and examined for morphological characteristics of apoptotic cell under light microscopy after incubated for 72 h. The rates of apoptotic cells of each group were examined with flow cytometry.ResultsThe cells of the control group showed normal appears, the serum hungry group had many cells with purple and blue particles in nuclei, but serum hungry with estrogen group had less such cells. The rate of apoptotic cell significantly increased in serum hungry group and decreased in serum hungry with estrogen group compared with the control group examined with flow cytometry (P<0.05).ConclusionEstrogen can repress osteoblasts apoptosis of rats induced by serum hungry.

A Case of Hungry Bone Syndrome after Parathyroidectomy / 대한신장학회잡지

Patients with secondary hyperparathyroidism usually present with a history of underlying disease such as chronic renal failure. Tertiary hyperparathyroidism usually exists in situations of secondary hyperparathyroidism. It occurs when parathyroid hyperplasia becomes so severe that removal of the underlying cause does not eliminate the stimulus for PTH secretion and hypertrophic chief cells become autonomous. Surgical parathyroidectomy sould be considered in patients with uncontrolled hyperparathyroidism. Hungry bone syndrome is known to be developed due to extensive remineralization of skeleton after parathyroidectomy. It is characterized by prolonged symptomatic hypocalcemia, as a complication of the parathyroidectomy for hyperthyroidism. We have experienced a female patient with hypercalcemia, who had been on maintenance hemodialysis for 15 years. She had elevated intact PTH and alkaline phosphatase. We decided parathyroidectomy because of uncontrolled hyperthyroidism despite of medical treatment. A few weeks after the operation she developed a muscle pain and arthralgia, which were found to be due to severe hypocalcaemia. Calcium suppletion led to normalization of the serum calcium level. she was discharged from the hospital in good condition after calcium supplement. We report a case of hungry bone syndrome developed after parathyroidectomy in this patient.

A Case of Hungry Bone Syndrome after Parathyroidectomy in Patient with Tertiary Hyperparathyroidism and Hemodialysis Patient / 대한내분비외과학회지

Hyperparathyroidism is a common finding in patients with chronic renal failure. Among the hyperparathyroidism, tertiary hyperparathyroidism, which is secreting parathyroid hormone autonomously in spite of hypercalcemia. Sometimes it requires surgical intervention due to not only symptomatic hypercalcemia, but also longstanding asymptomatic hypercalcemia. Hungry bone syndrome was known to be developed due to extensive re-mineralization of skeleton after parathyroidectomy. It is characteristic of persistent hypocalcemia, hypophosphatemia and often with tetany. The patient's condition improved without complication after the calcium chloride and calcium carbonate administration. We report a case of hungry bone syndrome developed after parathyroidectomy in patient with tertiary hyperparathyroidism and chronic renal failure.

A Case of Primary Hyperparathyroidism Associated with Proximal Renal Tubular Acidosis and Postoperative Hungry Bone Syndrome / 대한내분비학회지

Primary hyperparathyroidism is a generalezed disorder of calcium, phosphorus and bone metabolism due to an increased secretion of parathyroid hormone. Single parathyroid adenoma is the most common cause of primary hyperparathyroidism. Because parathyroid hormone has been proposed as an important inhibitor of renal bicarbonate reabsorption of proximal tubule, proximal renal tubular acidosis is not rare in primary hyperparaphyroidism. After parathyroid resection, significant hypocalcemia and hypophosphatemia requiring prolonged medical management may develop, termed hungery bone syndrome. We experienced a case of primary hyperparathyroidism associated with proximal renal tubular acidosis, and severe hungry bone syndrome after resection of the adenoma of parathyroid gland.