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A 61-year-old woman complains of a 1-year history of bone pains, anorexia, weight loss, and constipation. Serum calcium is elevated and she is diagnosed with primary hyperparathyroidism. She is treated surgically, with removal of her parathyroid adenoma. She then has a long period of hypocalcemia and requires continuous treatment with vitamin D and calcium. Subsequently, after 6 months she becomes normocalcemic and does not need therapy.
Which of the following conditions best explains these events?
A. Her remaining 3 parathyroid glands were destroyed
B. She has unrecognized pseudohypoparathyroidism
C. She had severe bone disease
D. She has pancreatitis from hyperparathyroidism
E. The wrong parathyroid gland was removed
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CCC...
Hungry bone syndrome
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usually the cause of that is ''relative hypoparathyroidism'': the normal parathyroid glands need some time to get back to their normal functioning leves after being inhibited by the high PTH secreted from the adenoma...
now, in case of LONG history of SEVERELY increased PTH due to an adenoma, then that increase PTH throughout time will result in a sever bone resorption over time... so after the adenoma is resected, the other normal parathyroid glands need some time to get back to normal, but in that case, even if they got back to normal, the pt will still have hypocalcemia due to the sever bone disease that was previously caused by the adenoma ( ie: there is not much enough bone left for the PTH to work on to increase the calcium levels)... and in that case, the pt might even develop seconday hyperpara due to that sever hypocalcemia ( and in pts with crhonic renal failure, that hypocalcemia will get exacerbated too)
so there r two scenarios here:
1- if the pt had the adenoma only for a short time, that wasnt enough to cause a sever bone disease, then the hypocalcemia should not last more than 1 or 2 weeks after the adenoma resected..
2- if the pt had the adenoma for a long time, then it might take up to few months untill the calcium levels are normalized, which is the case of our pt...
hope that helped..
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usually the cause of that is ''relative hypoparathyroidism'': the normal parathyroid glands need some time to get back to their normal functioning leves after being inhibited by the high PTH secreted from the adenoma...
now, in case of LONG history of SEVERELY increased PTH due to an adenoma, then that increase PTH throughout time will result in a sever bone resorption over time... so after the adenoma is resected, the other normal parathyroid glands need some time to get back to normal, but in that case, even if they got back to normal, the pt will still have hypocalcemia due to the sever bone disease that was previously caused by the adenoma ( ie: there is not much enough bone left for the PTH to work on to increase the calcium levels)... and in that case, the pt might even develop seconday hyperpara due to that sever hypocalcemia ( and in pts with crhonic renal failure, that hypocalcemia will get exacerbated too)
so there r two scenarios here:
1- if the pt had the adenoma only for a short time, that wasnt enough to cause a sever bone disease, then the hypocalcemia should not last more than 1 or 2 weeks after the adenoma resected..
2- if the pt had the adenoma for a long time, then it might take up to few months untill the calcium levels are normalized, which is the case of our pt...
hope that helped..
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The correct answer is C.
The patient initially had osteitis fibrosa cystica as a result of the primary hyperparathyroidism. When the adenoma was removed and PTH level decreased, the skeleton underwent rapid remineralization. This created an increase in calcium requirement. Once the repair was complete, the calcium demand decreased.
If the remaining glands were destroyed (choice A) she would have been permanently hypocalcemic.
In pseudohypoparathyroidism (choice B), there is end organ resistance to PTH, resulting in kidneys and bones being unresponsive. Patients have hypocalcemia and hyperphosphatemia.
Severe pancreatitis would cause saponification and hypocalcemia (choice D). She would also have symptoms of epigastric pain.
If the wrong gland were removed, she would be still hypercalcemic (choice E).
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