Hungry bone syndrome

Parathyroidectomy is a treatment of last resort for sHPT, but should be considered in patients with persistently elevated iPTH levels above 800 pg/mL (800 ng/L) that is refractory to medical therapy to lower serum calcium and/or phosphorus levels.39 A portion or all of the parathyroid tissue may be removed, and in some cases a portion of the parathyroid tissue may be transplanted into another site, usually the forearm. Bone turnover can be disrupted in patients undergoing parathyroidectomy whereby bone production outweighs bone resorption. The syndrome, known as hungry bone syndrome, is characterized by excessive uptake of calcium, phosphorus, and magnesium for bone production, leading to hypocalcemia, hypophosphatemia, and hypomagnesemia. Serum ionized calcium levels should be monitored frequently (every 4 to 6 hours for the first 48 to 72 hours) in patients receiving a parathyroidectomy. Calcium supplementation is usually necessary, administered IV initially, then orally (with vitamin D supplementation) once normal calcium levels are attained for several weeks to months after the procedure. 

Acute hemorrhagic and edematous pancreatitis Healing phase of bone disease of treated hyperparathyroidism, hyperthyroidism, and hematological malignancies (hungry bone syndrome)... 

Acute symptomatic hypocalcemia may be seen in hospitalized patients for various reasons. Rapid remineralization of bone after surgery for primary hyperparathyroidism (hungry bone syndrome), treatment for hyperthyroidism, or treatment for hematological malignancy may result in hypocalcemia. Acute hemorrhagic or edematous pancreatitis is frequently complicated by hypocalcemia. Vitamin D deficiency may also be associated with hypocalcemia because of impaired intestinal absorption of calcium and skeletal resistance to PTH. Osteomalacia and rickets are discussed in a later section of this chapter. 

A symptomatic rapid fall in serum calcium concentrations (often to values <7 mg/dL) is common in patients who have had a parathyroidectomy or thyroidectomy. Hypocalcemia in these postsurgical patients is generally transient in nature. " The hungry bone syndrome is a condition of profound hypocalcemia whereby the bone avidly in-... 

Hungry bone syndrome" after parathyroidectomy Internal redistribution... 

The authors hypothesized that chelation by deferasirox of iron from bone tissue had led to increased calcium uptake, the hungry bone syndrome , and they suggested that if deferasirox is used in patients on dialysis, serum calcium should be checked routinely. 

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