Management of hypocalcemia in a person with hungry bone syndrome post parathyroidectomy due to parathyroid carcinoma: a case report

Abstract

Introduction: Hungry Bone Syndrome (HBS) refers to a condition in the form of prolonged and severe hypocalcemia accompanied by hypophosphatemia and hypomagnesemia that occurs after parathyroidectomy. The sudden cessation of PTH production leads to increased bone re-mineralization and a rapid shift of calcium from circulation to bone. This case report aims to present our management of hypocalcemia in a person with HBS after he underwent parathyroidectomy surgery due to parathyroid carcinoma. Case Presentation: Mr. S, 46 years old, had a total thyroidectomy and a total parathyroidectomy on April 30th, 2019, due to parathyroid carcinoma, which the patient previously had. The patient was planned for surgery because of pathological fractures in the patient's hands and feet, which were complications of parathyroid carcinoma. The laboratory examination on the first postoperative day, May 1st, 2019, obtained a total calcium of 8.2 mg/dL. On May 5th, 2019 (day 5), total calcium decreased to 6.1 mg/dL. On May 10th, 2019 (day 10), hypophosphatemia was also found with a value of 2.1 mg/dL and hypomagnesemia of 1.2 mg/dL. When experiencing complaints, the patient's calcium was monitored regularly, low calcium was found, and symptoms of hypocalcemia were also found, so this patient was given drip calcium gluconate 1000 mg every 8 hours in 100 ml normal saline. Calcium checks are carried out every 24 hours; calcium is still low for over 3 days. In addition, he was given calcitriol 2x0.25 mcg titrated up to 2x0.5 mcg, drip 40% MgSO4 in 500 salines in 24 hours, and 4x200 oral phosphate. During the treatment, the patient's calcium reached 8.2 mg/dL with albumin 3.3 g/dL with a calcium ion count of 8.4 mg/dL after 17 days of treatment. Conclusion: HBS was found due to total parathyroidectomy as the main therapy for parathyroid carcinoma. Close calcium monitoring and early administration of postoperative calcium are needed to avoid complications from hypocalcemia. Avoiding HBS can reduce the number of days in the hospital, thereby saving costs and improving the patient's quality of life.