Info Nuggets
Hungry bones: The post-parathyroidectomy calcium crisis
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Hungry bone syndrome (HBS)
Introduction (brief overview)
Hungry bone syndrome (HBS) is a clinical condition characterised by severe, prolonged hypocalcemia (low blood calcium levels) that occurs after parathyroidectomy (surgical removal of the parathyroid gland), especially in patients with severe hyperparathyroidism.
After the removal of the overactive parathyroid gland, bones — previously demineralised due to excess parathyroid hormone (PTH) — suddenly begin to rapidly absorb calcium, phosphate and magnesium to rebuild bone mass. This causes a sudden drop in blood calcium levels, leading to symptoms of hypocalcemia.
Causes
Parathyroidectomy in patients with:
- Primary hyperparathyroidism (usually due to parathyroid adenoma)
- Secondary hyperparathyroidism (common in chronic kidney disease)
Long-standing high PTH levels cause:
- Bone resorption (calcium released from bones)
- Osteitis fibrosa cystica (weakened bones)
- Post-surgery, sudden withdrawal of PTH causes increased bone uptake of calcium, leading to HBS.
Clinical features/symptoms
- Muscle cramps
- Numbness, tingling
- Seizures
- Cardiac arrhythmias (in severe cases)
Diagnosis
- Low serum calcium
- Low magnesium and phosphate
- High alkaline phosphatase
- Normal or low PTH post-surgery
Management & Cure
Preventive care: Identify high-risk patients preoperatively (e.g. CKD, severe hyperparathyroidism)
Treatment:
- Calcium supplementation (oral/IV)
- Vitamin D analogues (e.g. calcitriol)
- Magnesium replacement (if deficient)
- Monitoring:
- Regular monitoring of electrolytes post-surgery
Relevance for UPSC
- GS Paper III – Science and technology/health and diseases
- Prelims – Conceptual understanding of medical syndromes, especially in context of endocrine disorders
- Mains (GS II / III) – Can be used in health-related answers, especially regarding non-communicable diseases or surgical complications
Sample question types for UPSC:
Prelims (objective)
Q. Hungry Bone Syndrome is associated with which of the following glands?
A) Thyroid
B) Adrenal
C) Parathyroid ✅
D) Pituitary
Mains (short note/GS III – science & tech)
Q. What is Hungry Bone Syndrome? Briefly explain its pathophysiology and management. (Answer in 150 words)
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