Severe Hypocalcemia in Hungry Bone Syndrome After Parathyroid Surgery: A Case Study and Review

BACKGROUND Hungry bone syndrome (HBS) is a severe, rapid, profound, prolonged, and sometimes fatal condition characterized by hypocalcemia, exacerbated by suppressed parathyroid hormone levels following parathyroidectomy in severe primary hyperparathyroidism (PHPT). PHPT is reported to affect 1% of the general population and its prevalence is increasing with age, with a prevalence rate of 2% among people over age 55 years. More than 80% of all cases of primary hyperparathyroidism are asymptomatic for most of the disease duration. CASE REPORT We described a rare case of primary hyperparathyroidism with brown tumors complicated by severe HBS after combined parathyroid and thyroid surgery. To the best of our knowledge, this is one of the first case reports ever published that presented with such a low level of calcium. Our patient required unprecedented amounts of calcium in the postoperative treatment during her hospital stay. The cumulative dose of intravenous calcium was 17 112 mg of elemental calcium. In this review we present signs and symptoms of HBS and discuss treatment and prevention methods of this syndrome. CONCLUSIONS When HBS occurs, hospitalization and aggressive intravenous calcium infusion should be continued until hypocalcemia resolves to prevent neuromuscular and cardiac complications. It is also essential to achieve normal magnesium levels. Currently, there are no specific treatment guidelines for HBS. This and similar case reports demonstrate appropriate diagnostic and therapeutic approaches and provides valuable guidance for clinicians. HBS can be prevented by early identification of risk factors and the use of calcitriol and bisphosphonates.