A Case of Parathyroid Carcinoma with Severe Hungry Bone Syndrome and Review of Literature

Abstract

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.

THERAPY OF ENDOCRINE DISEASE: Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature

“…Severe hypocalcaemia (serum calcium concentration %2.1 mmol/l) is associated with neuromuscular irritability, clinically manifested by carpopedal spasms, perioral paresthesiae, tingling extremities, Chvostek sign and Trousseau sign (15,16,17,18,19,20,21,22,23,24,25,26). Patients can also develop generalised convulsions, which can lead to pathological fractures (27,28), and ultimately if remaining uncorrected to coma and even death.…”

Severe and Symptomatic Calcium Disorders Caused by Secondary Bone Disease in a Patient with a Thyroid Storm

“…Four days after admission, hypocalcaemia developed, which we attributed to hungry bone syndrome. This condition is most commonly seen after parathyroidectomy [13]. When treatment for thyrotoxicosis is initiated, bone formation starts again, leading to an increased uptake of calcium in bone [14].…”

Parathyroid carcinoma and oxyphil parathyroid adenoma: an uncommon case of misinterpretation in clinical practice

“…On two occasions the patient manifested hypocalcemia. Hungry bone syndrome was expected to occur owing to the severity of bone involvement, leading to a decrease in serum calcium and phosphorus levels [37][38][39]. However, after the second parathyroidectomy, there was a sharp decrease in PTH levels associated with hypocalcemia and a slight augmentation of serum phosphate levels.…”