J Korean Thyroid Assoc.  2015 May;8(1):108-112. 10.11106/cet.2015.8.1.108.

Two Cases of Hungry Bone Syndrome after Huge Parathyroidectomy

• Lee H
• Kim J
• Park J
• Woo S

• KMID: 2149628
• DOI: http://doi.org/10.11106/cet.2015.8.1.108

Abstract

Hungry bone syndrome can occur after parathyroidectomy which is performed due to primary hyperparathyroidism. Hungry bone syndrome is characterized by showing postoperative hypocalcemia which is caused by the remineralization of various minerals, including calcium inside the bone. This syndrome requires a long term supplementation of calcium. Identifying the preoperative predictors of hypocalcemia is essential and important for postoperative management. From here on in, we report two cases of patients with parathyroid adenoma who have undergone parathyroidectomy. We would like to report and discuss the management of hungry bone syndrome experienced from the two cases that have been mentioned above. We report these two cases with a review of the literature.

Keyword

Parathyroidectomy; Hypocalcemia; Parathyroid hormone

MeSH Terms

Calcium
Humans
Hyperparathyroidism, Primary
Hypocalcemia
Minerals
Parathyroid Hormone
Parathyroid Neoplasms
Parathyroidectomy*
Calcium
Minerals
Parathyroid Hormone

Figure

• 

  Fig. 1. Neck ultrasonography of a parathyroid tumor which is 4.23×2.78×4.99 cm in size and well defined. And this tumor is also a homogeneous and hypoechoic mass which is round in shape.

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  Fig. 2. Computed tomographic images of parathyroid tumor. Left. thyroid lobe was displaced anteriorly by a irregularly defined heterogeneous enhanced mass which was finally reported as being an atypia of unknown significant of thyroid.

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  Fig. 3. Thallium scan (Tc-99m sestamibi parathyroid scintigraphy) shows increased focal uptake at the area of the Left. lobe of the thyroid gland in both images.

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  Fig. 4. A pathologic finding of a parathyroid adenoma with a stromal rim of a normal parathyroid tissue (arrow).

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  Fig. 5. Graph showing changes in serum PTH, Ca after the operation.

Reference

References

1. Wynne AG, van Heerden J, Carney JA, Fitzpatrick LA. Parathyroid carcinoma: clinical and pathologic features in 43 patients. Medicine (Baltimore). 1992; 71(4):197–205.

2. Brasier AR, Nussbaum SR. Hungry bone syndrome: clinical and biochemical predictors of its occurrence after parathyroid surgery. Am J Med. 1988; 84(4):654–60.

3. Albright F, Reifenstein EC. The parathyroid glands and metabolic bone disease. selected studies. Baltimore: Williams & Wilkins Co.;1948; p.xxvi–p.393.

4. Mizrachi A, Gilat H, Bachar G, Feinmesser R, Shpitzer T. Elevated parathyroid hormone levels after parathyroidectomy for primary hyperparathyroidism. Head Neck. 2009; 31(11):1456–60.

5. Mittendorf EA, McHenry CR. Persistent parathyroid hormone elevation following curative parathyroidectomy for primary hyperparathyroidism. Arch Otolaryngol Head Neck Surg. 2002; 128(3):275–9.

6. Graal MB, Wolffenbuttel BH. Consequences of long-term hyperparathyroidism. Neth J Med. 1998; 53(1):37–42.

7. Heath DA, Van't Hoff W, Barnes AD, Gray JG. Value of 1-alpha-hydroxy vitamin D3 in treatment of primary hyperparathyroidism before parathyroidectomy. Br Med J. 1979; 1(6161):450–2.

8. Boyle IT, Hodsman ID, Allam BF, Boyce B, McLennan I. 1-alpha-Hydroxyvitamin D3 in the management of primary hyperparathyroidism with bone disease. Calcif Tissue Res. 1977; 22(Suppl:415):

9. Malabu UH, Founda MA. Primary hyperparathyroidism in Saudi Arabia: a review of 46 cases. Med J Malaysia. 2007; 62(5):394–7.

10. Lee IT, Sheu WH, Tu ST, Kuo SW, Pei D. Bisphosphonate pretreatment attenuates hungry bone syndrome postoperatively in subjects with primary hyperparathyroidism. J Bone Miner Metab. 2006; 24(3):255–8.

11. Franca TC, Griz L, Pinho J, Diniz ET, Andrade LD, Lucena CS. et al. Bisphosphonates can reduce bone hunger after parathyroidectomy in patients with primary hyperparathyroidism and osteitis fibrosa cystica. Rev Bras Reumatol. 2011; 51(2):131–7.