MEDizzy - A 33-year-old teacher underwent an elective

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Parathyroid Gland

A 33-year-old teacher underwent an elective parathyroidectomy for 1° HPT. Her post-operative stay in the hospital was uneventful and she was discharged home on day 3. On day 5 postoperatively, she noticed tingling around her face, with spasms in hands and was re-admitted to the hospital. Investigations: corrected calcium level 2.02 mmol/L (2.2–2.6) serum phosphate 0.6 mmol/L (0.8–1.5) As a result she was commenced on oral calcium supplements. On day 7 post-operatively, symptoms recurred and a further fall in calcium level was noticed. corrected calcium level 1.89 mmol/L (2.2–2.6) serum phosphate 0.46 mmol/L (0.8–1.5) She was started on IV calcium gluconate and alfacalcidol. Which one of the following is the probable aetiology for her persistent hypocalcaemia?

ExplanationA. This woman likely would have had increased bone resorption due to increased osteoclastic activity, as a result of high PTH levels pre-operatively. Her post-operative hypocalcemia and hypophosphatasemia is probably due to the rapid uptake of calcium and phosphate by the bones, otherwise labelled as hungry bone syndrome