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Hungry Bone Syndrome — RACP Adult Medicine MCQ

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ModerateEndocrinologyHungry Bone SyndromeRACP Adult Medicine

A 55-year-old woman with newly diagnosed primary hyperparathyroidism undergoes parathyroidectomy. Post-operatively (day 2), she develops tetany, perioral tingling, and phosphate drops to 0.4 mmol/L. Calcium is 1.85 mmol/L. PTH is appropriately suppressed. ALP is rising. What is the most likely syndrome?

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Correct answer: A — Hungry bone syndrome

Post-parathyroidectomy hypocalcaemia and hypophosphataemia with rising ALP is hungry bone syndrome. After removal of the PTH-secreting adenoma, the skeleton rapidly takes up calcium and phosphate (previously mobilised by excess PTH). Risk factors: preoperative bone disease, vitamin D deficiency, large adenoma. Treatment: aggressive IV calcium and oral calcium/calcitriol replacement for days-weeks. ALP rise reflects increased osteoblastic activity.

Reference: eTG Endocrine – 2024 – Post-Parathyroidectomy; ESA 2024