Hyperparathyroidism and hungry bone syndrome revisited.

Area of Science:

• Endocrinology
• Oncology
• Surgical Pathology

Background:

• Primary hyperparathyroidism can manifest with severe hypercalcemia and elevated parathyroid hormone (PTH) levels.
• Parathyroid carcinoma is a rare cause of hyperparathyroidism, often presenting with markedly elevated PTH and calcium.
• Brown tumors are benign bone lesions associated with excessive PTH, representing osteitis fibrosa cystica.

Observation:

• A 36-year-old woman presented with severe hypercalcemia (15.7 mg/dL) and extremely elevated PTH (1549.6 pg/mL).
• Imaging suggested parathyroid carcinoma, and a bone biopsy revealed a brown tumor, not metastatic cancer.
• The patient underwent parathyroidectomy for presumed parathyroid carcinoma.

Findings:

• Surgical removal of the parathyroid tumor was performed.
• The patient developed symptomatic hypocalcemia following parathyroidectomy.
• The hypocalcemia was consistent with hungry bone syndrome, a known complication after parathyroid surgery.

Implications:

• This case highlights the diagnostic challenges in differentiating parathyroid carcinoma from other causes of severe hyperparathyroidism.
• Early recognition and management of hungry bone syndrome are crucial for patient recovery after parathyroidectomy.
• Understanding the bone manifestations of hyperparathyroidism, such as brown tumors, is essential for accurate diagnosis.