Parathyroid carcinoma and hungry bone syndrome

Abstract

SUMMARYWe hereby report two patients with parathyroid carcinoma presenting extremely high calcium and PTH levels, severe bone disease, and palpable neck mass at diagnosis. They both underwent parathyroidectomy, and one of them evolved to lung metastasis. Important hypocalcemia was observed after surgery in both: after parathyroidectomy in one patient, and only after surgical removal of the metastasis in the other. Both required intravenous calcium replacement, thus revealing hungry bone syndrome (HBS). HBS usually reflects rapid mineralization after correction of hyperparathyroidism. The more severe the bone disease before surgery, the more prone the patient is to HBS after surgery. Despite being an unfavorable outcome, HBS state suggests that surgical removal of hypersecretory parathyroid tissue was accomplished. In this study, HBS was observed in both patients, who presented severe bone disease prior to surgery. HBS would be expected post-operatively in successful parathyroid carcinoma removal. Arq Bras Endocrinol Metab. 2013;57(1):79-86SUMáRio O presente artigo descreve o relato de dois pacientes com carcinoma de paratiroide que apresentavam valores intensamente elevados de cálcio sérico e de PTH, associado a doença óssea e presença de nódulo cervical palpável ao diagnóstico. Ambos foram submetidos à paratiroidectomia, sendo que um evoluiu com metástases pulmonares. Hipocalcemia importante foi observada após a paratiroidectomia em um paciente e somente após remoção cirúrgica das metástases pulmonares em outro. Ambos necessitaram de reposição endovenosa de cálcio, revelando, assim, o estado de fome óssea (FO). A presença da FO usualmente reflete rápida mineralização óssea após correção do hiperparatiroidismo; assim, quanto mais severa a doença óssea previa à cirurgia, maior será a FO observada no pós-operatório desses pacientes. Embora inicialmente considerada um evento indesejável, a FO representa a bem-sucedida remoção cirúrgica do tecido paratiroideano hipersecretor. Fome óssea deve ser esperada no pós--operatório do tratamento cirúrgico bem-sucedido do carcinoma de paratiroide. Arq Bras Endocrinol Metab. 2013;57(1):79-86

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

“…Prevention of HBS has not been fully established. Some investigators have suggested that administration of bisphosphonates to PHP patients can prevent the development of HBS (23). Bisphosphonates have potent inhibitory effects on osteoclastic bone resorption, and are commonly used in the treatment of osteoporosis and hypercalcemia (20,24).…”

Perioperative Nursing of Patients with Reoperation of Recurrent Parathyroid Carcinoma Invading the Upper Digestive or Respiratory Tract

“…Appropriate nursing has a vital role in preventing adverse events during parathyroid carcinoma treatment [10]. For example, monitoring patients for hypocalcemia and active intervention are needed to prevent serious bone disease occurring [13]. In this study, we aimed to analyze and summarize the perioperative nursing care of patients with recurrent parathyroid carcinoma invading the upper digestive or respiratory tract.…”

“…But serum calcium reduction can result in serious bone disease. Osteoporosis or fibrous cystic osteitis are important features of hyperparathyroidism caused by parathyroid cancer, but postoperatively "bone starvation" is frequent [13]. erefore, prevention requires close observation of serum calcium changes and prompt treatment.…”