Two days after successful parathyroidectomy for a large parathyroid adenoma, a patient develops perioral tingling, carpopedal spasm, serum calcium of 6.8 mg/dL, phosphate of 5.9 mg/dL, and a PTH level below assay detection. What caused this complication?
- A Recurrent laryngeal nerve injury with hyperventilation
- B Vitamin D resistant rickets unmasked after surgery
- C Accidental excision of all four parathyroid glands
- D Rapid remineralisation of chronically demineralised bone consuming calcium and phosphate ✓
Explanation
Hungry bone syndrome occurs when longstanding high PTH has driven severe bone resorption; removal of the adenoma abruptly reverses osteoclastic activity, and vigorous osteoblastic remineralisation pulls calcium and phosphate out of blood faster than replacement can keep up, producing hypocalcaemia with HYPERphosphataemia and very low PTH. Accidental total parathyroidectomy would also give low PTH but hungry bone is the classic cause when a large adenoma and high preoperative alkaline phosphatase were present. Recurrent laryngeal injury causes hoarseness, not hypocalcaemia.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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Written and medically reviewed by the StethoPrep medical team.