Endocrine Abstracts

Objective: To highlight that an occasional case of parathyroidectomy may be followed by protracted symptomatic hypocalcaemia requiring calcium infusion and high doses of vitamin D.

Case: We report a 61 years male who presented with hypercalcaemia and brown tumour. He was diagnosed as a case of primary hyperparathyroidism. He had normal FBC, U&Es, LFT, TFT and negative Endomysial antibody. Just 4 days post-parathyroidectomy he was admitted with symptomatic hypocalcaemia. He needed 3 weeks continuous Ca infusion and large doses of Alfacalcidol and oral Ca before he became symptoms free. His Mg was also low which was replaced orally. Even now he was to be kept on high doses of vitamin D and Ca to maintain his Ca.

Discussion: The hungry bone syndrome post-parathyroidectomy is well known. It is due to avid Ca retention by bones after the source of high Parathormone causing increased mobilization of Ca from bones is removed. It usually lasts up to a week. In our case it has lasted many months still needing high doses of Ca and Alfacalcidol. The protracted hungry bone syndrome lasting up to a year has been reported following parathyroidectomy for secondary hyperparathyroidism in chronic renal failure. We did not find any case of prolonged hungry bone syndrome following parathyroidectomy for primary hyperparathyroidism. The reason for this prolonged hypocalcaemia was the late recovery of the remaining hypoplastic parathyroid as is evident from the results in the table. The low vitamin D before surgery in this case might have contributed to delayed recovery as has been suggested in a report from India.