혈액투석 환자에서 부갑상선 절제술 후 발생한 Hungry Bone Syndrome 1예

Abstract

Patients with secondary hyperparathyroidism usually present with a history of underlying disease such as chronic renal failure. Tertiary hyperparathyroidism usually exists in situations of secondary hyperparathyroidism. It occurs when parathyroid hyperplasia becomes so severe that removal of the underlying cause does not eliminate the stimulus for PTH secretion and hypertrophic chief cells become autonomous. Surgical parathyroidectomy sould be considered in patients with uncontrolled hyperparathyroidism. Hungry bone syndrome is known to be developed due to extensive remineralization of skeleton after parathyroidectomy. It is characterized by prolonged symptomatic hypocalcemia, as a complication of the parathyroidectomy for hyperthyroidism. We have experienced a female patient with hypercalcemia, who had been on maintenance hemodialysis for 15 years. She had elevated intact PTH and alkaline phosphatase. We decided parathyroidectomy because of uncontrolled hyperthyroidism despite of medical treatment. A few weeks after the operation she developed a muscle pain and arthralgia, which were found to be due to severe hypocalcaemia. Calcium suppletion led to normalization of the serum calcium level. she was discharged from the hospital in good condition after calcium supplement. We report a case of hungry bone syndrome developed after parathyroidectomy in this patient.