sunny2
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36 hours after surgical removal of a large parathyrodd adenoma, a 50y becomes irritable and developes hypocalcemia’signs, Ca 7.1 mg/dl, phosphorus 7.5 mg/dl, Magnesium 1.8 meq/l , What is the cause?
a. Atrophy of the following parathyoids
b. Hungry bone syndrome
c. Magnesium deficiency
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| Jinx
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b
its hungry bone synd
due to removal of PTH influence there is massive depn of Ca in bone causing hypocalcemia
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| msyamp
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hyngry bone syndrome
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| yasmeen
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 AGREE
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| achilles
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hungry bone syndrome.
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| som
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i go with A...
sunny2 canu post the ans
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| merrk
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A
the remaining parathyroid gland has been supressed for a long time, so will not start functioning immediately leading to hypocalcemia
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| msyamp
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is it?? so functioning parathyroid can lead to HYPOCALCEMIA?? i dint know.
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| sunny2
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Answer
B. Hungary Bone Syndrome
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| msyamp
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 HUNGARY bone syndrome
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| achilles
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actually A is what happens because of B !
over time, the normal parathyroid glands undergo atrophy because of the hyperfunctioning adenoma. so merrk was'nt totally off the point...thus for a few days Ca++ is monitored and till things begin to normalise the patient is given IV Ca++
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| guayoman
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The answer should be A. I posted a reference backing it up. But I found in Kap notes that hungry bones sd is the cause, it doesn't explain further.
Reference from http://gpnotebook.co.uk/simpleprocess.cfm?queryst... says:
"For primary hyperparathyroidism, surgery is indicated in all patients under the age of 60 years and in other patients with a serum calcium concentration above 3.00 mmol per litre.
Treated patients may show a mild transient state of hypoparathyroidism for several days or weeks afterwards until the remaining previously suppressed glands recover. Mild circumoral and digital paraesthesiae may occur and are easily controlled using iv or oral calcium.
Severe and prolonged low serum levels of calcium, magnesium, and phosphate may occur post-operatively and require an active vitamin D metabolite such as 1 HCC."
Edited by guayoman on 05/13/06 - 10:58 PM
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| guayoman
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Achilles: Is A what happens because of B? or B because of A? I just found literature which makes them sound as the same thing. It says: [left]Post-parathyroidectomy hypocalcemia[/left] [left]• Acute hypocalcemia usually occurs in the first 24 hours after surgery due to acutely lowered PTH.[/left] [left]• 12% of patients have persistent, symptomatic hypocalcemia, along with hypocalciuria, hypophosphatemia, and rising alk phos called Hungry Bone Syndrome.[/left] [left]• Symptoms include: Seizures, arrythmia, prolonged QT, numbness, tetany, parasthesias, Chvostek’s sign, Trousseau’s sign.[/left] [left]Mechanism[/left] [left]With no PTH around, osteoblastic activity is unbalanced by osteoclastic resorption, resulting in low calcium, phosphorus and rising alk phos. Low serum magnesium is also seen because of poor renal resorption in the prior high PTH state and then increased remineralization of bone in the new low PTH state.[/left] [left]So I figure that because of the lack of PTH (probably by atrophic glands) osteoblasts predominate over osteoclasts resuilting in hungry bone sd. [/left] [left]Can someone please differentiate the 2 diagnoses or are they the same thing?[/left]You can find it here: http://medicine.ucsf.edu/housestaff/Chiefs_cover_...
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| achilles
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guayoman , thats what i meant. they are the same thing(atleast thats what kaplan says) that A is the description of what happens in hungry bone syndrome. thanks for all the wonderful effort guayoman.
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| guayoman
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It will seem like I'm nagging...but I trully think it's the other way around. Sounds like unimportant point to make, but it makes the difference in this Q. The way I see it the answer is A, because B wouldn't happen without A happening first. Sunny 2 says the answer is B so I must be overlooking something. HELP
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| study_ing
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how long wud A take to manifest..is a strong contender with B as the answer. i wud vote for B but my reasons for ruling out A arent entirely solid.
guys what do ya think?
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| humbty
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I would clearly go for A its the acute setting. Hungry bone syndrome may or may not develop afterwards. But the reason for the hypocalcemia in this moment is just the atrophy of the parathyroid glands and insufficient PTH production. Guayomans reference is great.
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| frank100
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b
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| cbenitesch
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Ok here I go... This 50y.o.PO individual has developed irritability and hypocalcemia signs. Ok until then... irritability and hypocalcemia signs can be due to Hypomagnesemia, according to the choiches!... A) I think that´s not possible. so we get B) or C). We have low Calcium, low Mg and high Phosphorus. So Hypomagnesemia contributes to hipocalcemia. But I have a doubt with Phosphorus!, and in the other hand we have Hungry bone Synd. but it is characterized Calcium<8,5 mg/dL phosphorus <3mg/dL and hypomagnesemia, so we got the 3 of them!!!... and one more to finally decide is that Hypomagnesemia has Mg values on the inferior border line. So my answer is C).
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| cbenitesch
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Please post the answer!
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