J Korean Surg Soc.  2011 Nov;81(5):344-349. 10.4174/jkss.2011.81.5.344.

Hungry bone syndrome after parathyroidectomy of a minimally invasive parathyroid carcinoma

• Kim KM
• Park JB
• Bae KS
• Kang SJ

• KMID: 2096689
• DOI: http://doi.org/10.4174/jkss.2011.81.5.344

Abstract

The prognosis of parathyroid carcinoma varies significantly between numerous studies. Therefore, many attempts have been made to grade the degree of parathyroid carcinoma, and recently, classifying parathyroid carcinomas into either minimally invasive or widely invasive carcinoma- similar to follicular carcinoma of the thyroid- has led to a more reliable prediction of the prognosis. Hungry bone syndrome can occur if parathyroidectomy is performed due to primary hyperparathyroidism regardless of the cause of the disease. Hungry bone syndrome is characterized by postoperative a hypocalcemic state due to remineralization of various minerals, including calcium, of the bone; this syndrome requires a long-term supplementation of calcium. The authors aim to report, along with a review of related literatures, 1 case of a 29-year-old female patient diagnosed with minimally invasive parathyroid carcinoma who fell into hungry bone syndrome after parathyroidectomy.

Keyword

Parathyroid carcinoma; Parathyroidectomy; Hungry bone syndrome

MeSH Terms

Adult
Calcium
Female
Humans
Hyperparathyroidism, Primary
Minerals
Parathyroid Neoplasms
Parathyroidectomy
Prognosis
Calcium
Minerals

Figure

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  Fig. 1 Neck ultrasonography of parathyroid tumor. 2.02 × 1.7 × 2.93 cm sized, well defined, round shaped homogenous and hypoechoic extrathyroidal mass.

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  Fig. 2 High power finding of ultrasound guided-fine needle aspiration cytology. (A) The tumor cells forming a microfollicular pattern show slightly enlarged nuclei with mild atypia, abundant cytoplasm and oncocystic change (H&E, ×400). (B) Immunostain result of tumor cell using parathyroid hormone reveals that the origin of tumor cells is parathyroid gland.

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  Fig. 3 Compute tomographic finding of parathyroid tumor. Right thyroid lobe was displaced anteriorly by well defined heterogenous enhanced mass which was finally reported as a minimally invasive parathyroid carcinoma.

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  Fig. 4 Gross finding of parathyroid carcinoma case. (A) Tumor were well-encapsulated and external surface were smooth. (B) Tumor was bisected. The cut surface shows white-gray homogenous appearance.

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  Fig. 5 Grapes showing the postoperative changes of laboratory data. (A) Serum parathyroid hormone (PTH), alkaline phosphate (ALP). (B) Total calcium (Ca) and phosphate (P).

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  Fig. 6 Microscopic finding of parathyroid carcinoma case (H&E, ×100). (A) Focal invasion of tumor cells to parathyroid capsule. (B) Focal invasion of tumor cells to a single blood vessel.

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