Postoperative Hungry Bone Syndrome in Patients with Secondary Hyperparathyroidism of Renal Origin Melanie Goldfarb • Stephan S. Gondek • Susan M. Lim • Josephina C. Farra • Vania Nose • John I. Lew Published online: 8 March 2012 Ó Socie ´te ´ Internationale de Chirurgie 2012 Abstract Background Hungry bone syndrome (HBS) is a postop- erative condition of severe hypocalcemia that can be seen in patients who have undergone parathyroidectomy (PTX) for secondary hyperparathyroidism (2HPT) of renal origin. This study examines HBS in patients after PTX for 2HPT. Methods Prospectively collected data was retrospectively reviewed in patients who underwent PTX for 2HPT of renal origin at a single institution. HBS was defined as the need for additional days of hospitalization or readmission for intravenous calcium supplementation due to clinical symptoms of hypocalcemia, including tingling, muscle spasms, and bone pain and/or immediate postoperative low serum calcium B7.5 mg/dl. Results Of 79 patients who underwent PTX for 2HPT, 27.8% (n = 22) experienced HBS. Young age (B45 years, p = 0.02) was the only preoperative variable that predicted HBS. Most patients developed HBS within 18 h after surgery and required a prolonged hospital stay (19/22) compared to those requiring hospital readmission within the first 7 days (3/22). Initial postoperative serum calcium levels within 18 h of surgery were significantly lower in those patients who developed HBS (7.1 vs. 8.3 mg/dl, p = 0.001), and those patients also had a greater absolute decrease in serum calcium (2.8 vs. 3.5 mg/dl, p = 0.04). Conclusion HBS develops in a significant proportion of patients generally within the first 18 h after subtotal PTX for 2HPT. The only identifiable preoperative risk factor for HBS was young age. Additionally, low initial calcium levels and greater absolute decrease in serum calcium may help identify those patients that will develop HBS requiring judicious calcium supplementation. Introduction Hyperparathyroidism secondary to renal disease was first described in 1934 [1, 2]. However, in that predialysis era, very few patients were classified as having end-stage renal disease (ESRD). With the advent of routine dialysis therapy by which patients live longer with ESRD, para- thyroidectomy (PTX) to ameliorate the symptoms and electrolyte imbalances of chronically elevated parathor- mone (PTH) levels became necessary. Stanbury et al. [3] reported the first subtotal parathyroidectomy for the treat- ment of secondary hyperparathyroidism of renal origin in 1960, followed in 1968 by Alveryd [4] who described total parathyroidectomy with autografting for 2HPT that was later pioneered by Wells [5]. Secondary hyperparathyroidism (2HPT) is common in patients with chronic kidney disease, and nearly all patients with ESRD will develop 2HPT [6]. Conventional medical treatment of 2HPT of renal origin includes dietary phos- phate restriction, phosphate binders, active vitamin D M. Goldfarb Á S. M. Lim Á J. C. Farra Á J. I. Lew Division of Endocrine Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA M. Goldfarb (&) Division of Breast/Soft Tissue and Endocrine Surgery, Department of Surgery, University of Southern California Keck School of Medicine, 1441 Eastlake Ave, Suite 3411, Los Angeles, CA 90033, USA e-mail: Melanie.Goldfarb@med.usc.edu S. S. Gondek Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA V. Nose Division of Endocrine Pathology, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA 123 World J Surg (2012) 36:1314–1319 DOI 10.1007/s00268-012-1560-x