Transient teriparatide for postoperative hypocalcaemia with hungry bone features

Area of Science:

• Endocrinology
• Metabolic Bone Disease

Background:

• Postoperative hypocalcaemia following parathyroidectomy presents management challenges.
• Severe primary hyperparathyroidism can lead to significant skeletal complications and electrolyte disturbances.

Purpose of the Study:

• To report a case of persistent postoperative hypocalcaemia managed with teriparatide.
• To highlight teriparatide's potential role in refractory hypocalcaemia with hungry bone physiology.

Main Methods:

• A 50-year-old male with severe primary hyperparathyroidism underwent parathyroidectomy.
• Developed persistent hypocalcaemia despite standard treatment, requiring ICU admission.
• Initiated teriparatide (20 µg twice daily, then once daily) on postoperative day 11.

Main Results:

• Teriparatide administration led to progressive normalization of calcium levels.
• Intravenous supplementation was discontinued, enabling early hospital discharge.
• Sustained calcium-phosphate balance was achieved without hypocalcaemia recurrence during follow-up.

Conclusions:

• Short-term teriparatide can serve as effective rescue therapy for persistent postoperative hypocalcaemia.
• This approach is particularly beneficial in patients with hungry bone syndrome post-parathyroidectomy.
• Teriparatide offers a viable option for managing complex hypocalcaemia cases.