Hungry bone syndrome following parathyroidectomy - a case report

Milena Lackovic Badiu; Bojan Joksimovic; Vladimir Samardzic; Marija Sinik; Martina Tomasovic; Milos Marinkovic; Sonja Zafirovic; Isenovic Esma R.; Milan Obradovic; Emina Sudar-Milovanovic; Zoran Gluvic

doi:10.1530/endoabs.99.EP1221

EP1221

Prev Next

Section Contents Cite

Endocrine Abstracts (2024) 99 EP1221 | DOI: 10.1530/endoabs.99.EP1221

ECE2024 Eposter Presentations Calcium and Bone (102 abstracts)

Hungry bone syndrome following parathyroidectomy - a case report

Milena Lackovic ¹ , Bojan Joksimovic ¹ , Vladimir Samardzic ¹ , Marija Sinik ¹ , Martina Tomasovic ¹ , Milos Marinkovic ¹ , Sonja Zafirovic ² , Esma R. Isenovic ² , Milan Obradovic ² , Emina Sudar-Milovanovic ² & Zoran Gluvic ¹

Err

Author affiliations

¹Zemun Clinical Hospital, Dept. of Endocrinology, Belgrade, Serbia, ²“VINČA” Institute of Nuclear Sciences – National Institute of the Republic of Serbia, Department of Radiobiology and Molecular Genetics, Belgrade

One of the main causes of protracted, severe hypocalcemia after parathyroidectomy is hungry bone syndrome (HBS). We report the case of a 40-year-old man who was first admitted to the Endocrinology department of Zemun Clinical Hospital (ZCH) in order to perform a workup for hypercalcemia. Further laboratory and imaging diagnostics indicated that a giant parathyroid adenoma, measuring approximately 6 cm in size, was the cause of the hypercalcaemia. An endocrine surgeon at the Clinical Centre of Serbia performed a lower left parathyroidectomy and a left thyroid lobectomy due to intraoperative detection of suspicious thyroid nodule. Patient was readmitted to ZCH shortly after surgery, exhibiting hypocalcaemia symptoms and signs. He began receiving intense parenteral and oral calcium and vitamin D substitution, which he continued after his discharge. The histology examination of the removed lower parathyroid gland and left thyroid lobe pointed to an atypical parathyroid adenoma and micropapillary cancer. His findings from tests at follow-up revealed low normal serum calcium levels, elevated PTH, and decreased vitamin D. Patient is additionally being prepared for another thyroid surgery. Despite being rare, the risk of developing HBS following a parathyroidectomy should not be ignored, especially in the presence of several preoperative predictors (e.g. giant parathyroid adenoma, higher preoperative PTH, calcium or alkaline phosphatase levels, etc.). Treatment for HBS must be individualized for each patient and could require an extended period of time.