Hungry bone syndrome associated to secondary hyperparathyroidism due to chronic renal failure

Abstract

Hungry bone syndrome (HBS) after parathyroidectomy is characterized by an increase in the bone uptake of calcium, phoshate and magnesium induced by the acute descent of parathyroid hormone. Hypocalcemia is frequent following surgery for secondary hyperparathyroidism in patients with chronic kidney disease. It may be abrupt and associated with clinical manifestations such as tetany and seizures. Severe hypophosphatemia and hypomagnesemia may be present but are unusual in patients with chronic kidney disease. The factors that predict HBS are related to the severity of the hyperparathyroidism and bone compromise (i.e., elevation of alkaline phosphatase, bone pain and radiologic findings). We suggest initiating i.v. calcium gluconate using a continuous infusion pump and central venous catheter immediately after surgery. High-calcium hemodyalisis bath is recommended. Oral calcium and calcitriol supplements should be administered as soon as possible. There is a wide variation in calcium and calcitriol requirement. Treatment is to be adjusted according to frequent laboratory controls. Calcium and vitamin D doses should be reduced gradually. Patients with severe bone disease may need prolonged treatment with calcium and vitamin D. An intensive and multidisciplinary follow-up after surgery and in the long term are mandatory to ensure patient safety and favorable outcome.