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hungry bone syndrome
After parathyroidectomy for cases of severe, prolonged hyperparathyroidism, hypocalcemia with hypophosphatemia may occur as a result of deposition of hydroxyapatite in the calcium-depleted skeleton.
Etiology:
1) osteitis fibrosa cystica
2) hyperthyroidism (case reports)
3) risk factors
a) larger volume of resected adenoma
b) higher preoperative blood urea nitrogen
c) higher preoperative serum alkaline phosphatase
d) older age
Epidemiology:
1) uncertain
2) incidence 13% in one study
Pathogenesis:
1) acute reversal of PTH-induced bone resorption
2) net increase in bone uptake of Ca+2, H2PO4-, Mg+2
Laboratory:
1) normal or even elevated serum PTH
2) serum calcium: hypocalcemia
3) serum phosphorus: hypophosphatemia
4) serum magnesium: hypomagnesemia on 3rd postoperative day
5) serum potassium: hyperkalemia in dialysis patients
Management:
- see parathyroidectomy
Related
hydroxyapatite
hyperparathyroidism
General
hypocalcemia
hypophosphatemia
syndrome
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 16. 18.
American College of Physicians, Philadelphia 1998, 2012, 2018.
- UpToDate 11.2 2003
http://www.uptodate.com
- Mittendorf EA, Merlino JI, McHenry CR.
Post-parathyroidectomy hypocalcemia: incidence, risk factors,
and management.
Am Surg. 2004 Feb;70(2):114-9;
PMID: 15011912
- Kaderli RM, Riss P, Dunkler D et al
The impact of vitamin D status on hungry bone syndrome after
surgery for primary hyperparathyroidism.
Eur J Endocrinol. 2018 Jan;178(1):1-9.
PMID: 28877925