We present a 45 year old female who was initially seen by Rheumatologist with long standing knee pain affecting her mobility. She was found to be severely hypercalcaemic and exhibited features suggestive of parathyroid carcinoma (palpable neck mass, extremely high parathyroid hormone, high alkaline phosphatase, concomitant presence of renal disease and skeletal involvement). Hence she was referred for parathyroidectomy. Postoperatively she developed profound hypocalcaemia with markedly raised serum alkaline phosphatase, requiring intensive intravenous calcium and oral vitamin D supplements, consistent with the development of hungry bone syndrome (HBS). HBS is a complication of parathyroid surgery where the correction of primary hyperparathyroidism is associated with rapid bone remineralisation, causing severe and prolonged hypocalcaemia. HBS is relatively rare but has to be considered in the differential diagnosis of postoperative hypocalcaemia particularly in severe cases. In the current report, we discuss pathogenesis, clinical course and management of HBS.
Abstract:Striae distensae are common innocuous skin lesions. We report a patient of nephrotic syndrome with corticosteroid-induced large striae, which suddenly developed bulging and fluid accumulation. There were no associated cutaneous or systemic symptoms. Analysis of aspirated fluid showed it was a transudate and culture was sterile. It was concluded that edema fluid, as part of anasarca, had preferentially accumulated within the striae, probably due to their altered dermal mechanical properties. Recognizing this entity is important to avoid unnecessary alarm or irrational use of antibiotics.
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