Hyperparathyroidism and hungry bone syndrome revisited

A 36-year-old woman presented with a calcium level of 15.7 mg/dL (normal, 8.5-11.0 mg/dL) and an extremely elevated parathyroid hormone level of 1549.6 pg/mL (normal, 10.0-65.0 pg/ mL). She subsequently underwent a parathyroid scan and ultrasound evaluation, which suggested parathyroid carcinoma. Biopsy of a lytic lesion in her left iliac bone was performed because of concern for metastatic disease but revealed a brown tumor. The patient then underwent parathyroidectomy. The patient's postsurgical course was complicated by protracted symptomatic hypocalcemia consistent with hungry bone syndrome.