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Hungry Bone Syndrome Post-Parathyroidectomy — ESENeph MCQ

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ModerateElectrolyte DisordersHungry Bone Syndrome Post-ParathyroidectomyESENeph

A 60-year-old man with CKD G5D on haemodialysis has been diagnosed with secondary hyperparathyroidism resistant to medical therapy. He undergoes subtotal parathyroidectomy. Post-operatively, his calcium drops to 1.6 mmol/L and phosphate falls to 0.5 mmol/L. What syndrome has occurred?

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Correct answer: D — Hungry bone syndrome – rapid uptake of calcium and phosphate into demineralised bone after parathyroidectomy

Hungry bone syndrome occurs after parathyroidectomy for severe hyperparathyroidism. The sudden drop in PTH removes the osteoclastic stimulus, while remineralisation of the demineralised skeleton avidly takes up calcium and phosphate from the blood, causing severe hypocalcaemia and hypophosphataemia. It can last weeks to months. Treatment requires aggressive IV calcium infusion (often continuous), oral calcium, and active vitamin D (Alfacalcidol/Calcitriol). Magnesium should also be checked and replaced. It is more severe when pre-operative PTH was very high and ALP was markedly elevated.

Reference: KDIGO 2017 – CKD-MBD; Witteveen et al 2013 – Hungry Bone Syndrome