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Post-parathyroidectomy Hungry Bone Syndrome

Severe hypocalcaemia following parathyroid surgery.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Endokrinoloji department. Book Appointment →

What is Post-parathyroidectomy Hungry Bone Syndrome?

Hungry bone syndrome is the rapid and avid uptake of calcium, phosphate and magnesium by previously demineralised bone after correction of long-standing hyperparathyroidism. It develops in 10-15% of patients undergoing parathyroidectomy for primary hyperparathyroidism and is more common after surgery for renal hyperparathyroidism.

Hypocalcaemia is severe (calcium below 8.4 mg/dL) and persists beyond the first 4 days after surgery; tetany, paraesthesia, Chvostek and Trousseau signs and prolonged QT may occur. Hypophosphataemia and hypomagnesaemia accompany the syndrome.

Higher risk factors include preoperative very high PTH and alkaline phosphatase, large adenomas, advanced osteitis fibrosa cystica, chronic kidney disease and vitamin D deficiency.

Symptoms

Symptomatic hypocalcaemia (paraesthesia, tetany)
Positive Chvostek and Trousseau signs
Muscle cramps and spasms
Prolonged QT and arrhythmia
Severe hypophosphataemia
Hypomagnesaemia
Persistent fatigue and weakness

Risk Factors

Long-standing severe hyperparathyroidism
Markedly elevated preoperative PTH and alkaline phosphatase
Large adenoma or hyperplasia
Advanced osteitis fibrosa cystica
Chronic kidney disease and dialysis
Severe preoperative vitamin D deficiency
Older age

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Symptomatic hypocalcaemia after parathyroid surgery
  • Severe paraesthesia, muscle spasm or tetany
  • Persistent low calcium beyond the early postoperative period
  • Worsening hypophosphataemia or hypomagnesaemia

Treatment Methods

01
Intravenous calcium gluconate in severe hypocalcaemia
02
High-dose oral calcium replacement
03
Active vitamin D analogues (calcitriol)
04
Magnesium replacement
05
Phosphate replacement when needed
06
Frequent monitoring of calcium and electrolytes
07
Adequate vitamin D supplementation in the preoperative period

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.