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Endocrine Abstracts (2015) 38 P111 | DOI: 10.1530/endoabs.38.P111

Walsall Healthcare NHS Trust, Walsall, UK.

An 18-year-old female presented to acute services with polydipsia and lower back pain. Routine blood tests revealed hypercalcaemia 3.67 mmol/l with significantly raised parathyroid hormone levels 2986 ng/l (10–65), alkaline phosphatase (ALP) 3330 IU/l (30–130), and low vitamin D 10.3 nmol/l (50–220). A CT scan revealed a 3.5 cm parathyroid adenoma and very osteopenic bones with multiple lucencies in keeping with primary hyperparathyoidism. The parathyroid subtraction scan Tc/MIBI reported a large area of activity in the lower left lobe of the thyroid gland corresponding with the CT findings.

The patient subsequently underwent parathyroidectomy for a 3.5 cm parathyroid adenoma weighing 15 g with histology showing chief cell adenoma. The patient’s calcium dropped within 24 h post surgery and she became symptomatic with Chvostek’s sign positive, carpopedal spasms, perioral numbness, and paraesthesia. Calcium was1.87 mmol/l and despite treatment dropped to 1.63 mmol/l, phosphate 0.6 mmol/l, and magnesium 0.5 mmol/l.

She required prolonged high dose i.v. calcium and magnesium infusions with oral phosphate, high doses of oral calcium and activated vitamin D supplementation for ‘hungry bone syndrome’ which continued for over a month. This case highlights a particularly severe case of primary hyperparathyroidism with rarely seen radiological features and development of rare post-operative complications. Despite acknowledgement of the risk, development of hungry bone syndrome was not avoided and the patient spent a significant number of days as an inpatient. This case describes in detail the large amounts of calcium and magnesium replacement regimes required (including i.v. regimes for over a month) that have not previously been documented in literature. It also discusses the potential risk factors for development of hungry bone syndrome.

Volume 38

Society for Endocrinology BES 2015

Edinburgh, UK
02 Nov 2015 - 04 Nov 2015

Society for Endocrinology 

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