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Hungry bone syndrome — SCE Endocrinology MCQ

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HardCalcium/BoneHungry bone syndromeSCE Endocrinology

A 56-year-old woman develops profound hypocalcaemia after parathyroidectomy for severe primary hyperparathyroidism. Preoperative ALP was markedly raised and radiographs showed subperiosteal bone resorption. Calcium falls to 1.68 mmol/L with low phosphate and high bone-specific ALP. What is the most likely diagnosis?

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Correct answer: A — Hungry bone syndrome

After removal of severe PTH excess, rapid skeletal remineralisation can cause hungry bone syndrome with prolonged hypocalcaemia and low phosphate. Permanent hypoparathyroidism usually has high phosphate and does not explain the high bone-turnover context as well. The pearl is to anticipate this in severe bone disease before surgery.

Reference: NICE NG132, Society for Endocrinology calcium guidance