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Atypical Parathyroid Adenoma Complicated with Protracted Hungry Bone Syndrome after Surgery: A Case Report and Literature Review.

Juárez-León ÓA, Gómez-Sámano MÁ, Cuevas-Ramos D, Almeda-Valdés P, López-Flores A La Torre MA, Reza-Albarrán AA, Gómez-Pérez FJ - Case Rep Endocrinol (2015)

Bottom Line: Bone densitometry showed decreased Z-Score values (total lumbar Z-Score of -4.2).Therefore we propose the term "Protracted HBS" in patients with particularly long recovery of 1 year.We present a literature review of the diagnosis, pathophysiology, and treatment of HBS.

View Article: PubMed Central - PubMed

Affiliation: Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico.

ABSTRACT
Hungry Bone Syndrome refers to the severe and prolonged hypocalcemia and hypophosphatemia, following parathyroidectomy in patients with hyperparathyroidism. We present the case of an eighteen-year-old woman with a four-year history of hyporexia, polydipsia, weight loss, growth retardation, and poor academic performance. The diagnostic work-up demonstrated primary hyperparathyroidism with hypercalcemia of 13.36 mg/dL, a PTH level of 2551 pg/mL, bone brown tumors, and microcalcifications within pancreas and kidneys. Neck ultrasonography revealed a parathyroid adenoma of 33 × 14 × 14 mm, also identified on (99)Tc-sestamibi scan. Bone densitometry showed decreased Z-Score values (total lumbar Z-Score of -4.2). A right hemithyroidectomy and right lower parathyroidectomy were performed. Pathological examination showed an atypical parathyroid adenoma, of 3.8 g of weight and 2.8 cm in diameter. After surgery she developed hypocalcemia with tetany and QTc interval prolongation. The patient required 3 months of oral and intravenous calcium supplementation due to Hungry Bone Syndrome (HBS). After 42 months, she is still under oral calcium. Usually HBS lasts less than 12 months. Therefore we propose the term "Protracted HBS" in patients with particularly long recovery of 1 year. We present a literature review of the diagnosis, pathophysiology, and treatment of HBS.

No MeSH data available.


Related in: MedlinePlus

Abdominal computed tomography (CT) on admission. (a) Diffuse pancreatic calcifications; (b) bilateral kidney calcifications on axial computed tomography. Findings are marked with white arrow heads.
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fig1: Abdominal computed tomography (CT) on admission. (a) Diffuse pancreatic calcifications; (b) bilateral kidney calcifications on axial computed tomography. Findings are marked with white arrow heads.

Mentions: Skeletal X-rays showed skull with “salt and pepper” lesions, vertebral compression fractures, brown tumors within the left humerus, and profuse calcifications within the pancreas and kidneys (Figure 1). The patient did not refer to abdominal pain, nor any symptomatology related to endocrine and exocrine pancreatic insufficiency. The electrocardiogram was unremarkable. Abdominal ultrasound revealed kidney stones causing bilateral dilation of the renal pelvis. Neck ultrasonography showed microcalcifications within a large echogenic mass, posterior to the right lobe of the thyroid gland of 33 × 14 × 14 mm, Figure 2. A 25 mCi 99Tc-sestamibi scintigraphy reported persistence of the radionuclide material at 120 minutes in the right inferior parathyroid gland at the same location of the mass shown in the US, Figure 3. Bone densitometry showed decreased Z-Score values (total lumbar Z-Score of −4.2), Table 2. Primary hyperparathyroidism secondary to a large parathyroid tumor was diagnosed.


Atypical Parathyroid Adenoma Complicated with Protracted Hungry Bone Syndrome after Surgery: A Case Report and Literature Review.

Juárez-León ÓA, Gómez-Sámano MÁ, Cuevas-Ramos D, Almeda-Valdés P, López-Flores A La Torre MA, Reza-Albarrán AA, Gómez-Pérez FJ - Case Rep Endocrinol (2015)

Abdominal computed tomography (CT) on admission. (a) Diffuse pancreatic calcifications; (b) bilateral kidney calcifications on axial computed tomography. Findings are marked with white arrow heads.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660009&req=5

fig1: Abdominal computed tomography (CT) on admission. (a) Diffuse pancreatic calcifications; (b) bilateral kidney calcifications on axial computed tomography. Findings are marked with white arrow heads.
Mentions: Skeletal X-rays showed skull with “salt and pepper” lesions, vertebral compression fractures, brown tumors within the left humerus, and profuse calcifications within the pancreas and kidneys (Figure 1). The patient did not refer to abdominal pain, nor any symptomatology related to endocrine and exocrine pancreatic insufficiency. The electrocardiogram was unremarkable. Abdominal ultrasound revealed kidney stones causing bilateral dilation of the renal pelvis. Neck ultrasonography showed microcalcifications within a large echogenic mass, posterior to the right lobe of the thyroid gland of 33 × 14 × 14 mm, Figure 2. A 25 mCi 99Tc-sestamibi scintigraphy reported persistence of the radionuclide material at 120 minutes in the right inferior parathyroid gland at the same location of the mass shown in the US, Figure 3. Bone densitometry showed decreased Z-Score values (total lumbar Z-Score of −4.2), Table 2. Primary hyperparathyroidism secondary to a large parathyroid tumor was diagnosed.

Bottom Line: Bone densitometry showed decreased Z-Score values (total lumbar Z-Score of -4.2).Therefore we propose the term "Protracted HBS" in patients with particularly long recovery of 1 year.We present a literature review of the diagnosis, pathophysiology, and treatment of HBS.

View Article: PubMed Central - PubMed

Affiliation: Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico.

ABSTRACT
Hungry Bone Syndrome refers to the severe and prolonged hypocalcemia and hypophosphatemia, following parathyroidectomy in patients with hyperparathyroidism. We present the case of an eighteen-year-old woman with a four-year history of hyporexia, polydipsia, weight loss, growth retardation, and poor academic performance. The diagnostic work-up demonstrated primary hyperparathyroidism with hypercalcemia of 13.36 mg/dL, a PTH level of 2551 pg/mL, bone brown tumors, and microcalcifications within pancreas and kidneys. Neck ultrasonography revealed a parathyroid adenoma of 33 × 14 × 14 mm, also identified on (99)Tc-sestamibi scan. Bone densitometry showed decreased Z-Score values (total lumbar Z-Score of -4.2). A right hemithyroidectomy and right lower parathyroidectomy were performed. Pathological examination showed an atypical parathyroid adenoma, of 3.8 g of weight and 2.8 cm in diameter. After surgery she developed hypocalcemia with tetany and QTc interval prolongation. The patient required 3 months of oral and intravenous calcium supplementation due to Hungry Bone Syndrome (HBS). After 42 months, she is still under oral calcium. Usually HBS lasts less than 12 months. Therefore we propose the term "Protracted HBS" in patients with particularly long recovery of 1 year. We present a literature review of the diagnosis, pathophysiology, and treatment of HBS.

No MeSH data available.


Related in: MedlinePlus