Abstract: PUB067
Postparathyroidectomy Hungry Bone Syndrome Resulting in a Pathological Femoral Neck Fracture in a Patient with ESRD
Session Information
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Easow, Benjamin M., Southeast Health, Dothan, Alabama, United States
- Mathew, Tijin A, Southeast Health, Dothan, Alabama, United States
- George, Lydia, Southeast Health, Dothan, Alabama, United States
- Jiby, Sandhra, Dr Somervell Memorial CSI Medical College and Hospital, Thiruvananthapuram, KL, India
- Thomas, Greeshma A., Southeast Health, Dothan, Alabama, United States
Introduction
Hungry Bone Syndrome (HBS) is a known complication after parathyroidectomy, especially in patients with ESRD and longstanding secondary hyperparathyroidism. It involves profound, prolonged hypocalcemia from rapid remineralization of chronically demineralized bone. We present a case of unusually severe, prolonged HBS complicated by a pathological fracture and delayed surgery.
Case Description
A 38-year-old male with ESRD on hemodialysis, longstanding secondary hyperparathyroidism (PTH >3000 pg/mL for years), and hypertension underwent subtotal parathyroidectomy with autotransplantation to the left sternocleidomastoid on 01/07/2025. Postoperatively, asymptomatic hypocalcemia was noted (7.8 mg/dL from 8.1 mg/dL pre-op). He was started on IV calcium gluconate and oral calcium. On POD1, calcium dropped to 5.7 mg/dL. PTH was 5.7 pg/mL, phosphorus 4.5 mg/dL. Calcitriol 1 mcg BID was started.
Despite several days of calcium carbonate 2500 mg q4h, IV calcium, and calcitriol, levels remained suboptimal. He was discharged on 01/19/25 with calcium 6.7 mg/dL. On 01/25/25, he returned with paresthesias; calcium was 5.6 mg/dL and QTc 540 ms. IV calcium chloride, oral calcium, and calcitriol were resumed. Magnesium was closely monitored and corrected. Calcium persisted at 6.5–6.7 mg/dL.
During prolonged hospitalization, he sustained a pathological right femoral neck fracture on 02/04/25. Surgery was delayed due to poor healing risk. With continued IV calcium and fluid overload, infusion was switched to IV calcium gluconate with daily dialysis. Hecterol 20 mcg TIW and alternating-day calcitriol were started. Calcium remained 6.5–7.2 mg/dL. On 02/15/25, he underwent right total hip arthroplasty. Post-op calcium was 6.1 mg/dL but asymptomatic. IV calcium was increased to 4 g q4h which raised calcium to 9.6 by 02/24/25. He was then discharged on 03/01/25.
Discussion
This case highlights severe HBS in ESRD with prolonged hypocalcemia refractory to high-dose calcium and vitamin D. A pre-op PTH >3000 pg/mL dropped to 5.7 post-op, triggering rapid bone calcium uptake. Hypocalcemia persisting >4 days require IV calcium if <7.6 mg/dL. Ongoing supplementation, close monitoring, and multidisciplinary care are critical. Complications like pathological fractures stress the need for early recognition.