Hungry bone syndrome (HBS) refers to a severe, rapid and prolonged hypocalcemia associated with hypophosphatemia and hypomagnesaemia that are the consequences of suppressed parathyroid hormone levels at patients with prior high bone turnover [1-6, 9, 11, 12].
We present a case of a foreseen hungry bone syndrome which turned out to be severe and atypical in spite of the administration of IV bisphosphonates prior to the surgery and the important substitution doses of calcium and vitamin D [1,3, 10].
The association between renal impairment, low 25(OH)-vitamin D, anemia, marrow fibrosis, severe osteoporosis, fibrocystic osteitis, high level of alkaline phosphatase and considerable volume of the parathyroid adenoma suggested a long neglected primary hyperparathyroidism and were considerable risk factors for a postoperative hungry bone syndrome.
Hungry bone syndrome is a severe complication of neglected primary hyperparathyroidism, which associated with iron-deficiency, megaloblastic anemia and bone fibrosis, besides the renal failure, suggests that the severity was determined by the term of hyperparathyroidism and the increased number of complications.
Bisphosphonate pretreatment attenuates hungry bone syndrome postoperatively in subjects with primary hyperparathyroidism.
With a diagnosis of hungry bone syndrome, oral calcium and vitamin D supplementations were started.
Postoperative persistence of elevated PTH levels should be interpreted with serum calcium, phosphorus, and vitamin D levels for the differential diagnosis of unsuccessful surgery, hungry bone syndrome, and vitamin D deficiency.
Acidosis (correction of), blood transfusions (massive), epinephrine, hungry bone syndrome
, insulin/glucose/refeeding syndrome, pancreatitis (acute)