Categories: Endocrinology

Hunger Bone Syndrome: Mechanism

Hungry Bone syndrome is a phenomenon of post-operative hypocalcemia. It is an uncommon, but serious post-surgical sequalae of parathyroidectomy.

It is profound and sustained hypocalcaemia (often with concurrent hypomagnesaemia and hypophosphataemia) despite a normal PTH.

The primary patient demography is those with severe primary hyperparathyroidism and preoperative high bone turnover (osteitis fibrosa).

WHY? The severe hypocalcaemia is thought to be secondary to increased influx of calcium into bone, due to the sudden loss of high circulating levels of PTH on chronically elevated osteoclastic resorption.


  1. Ho L-Y, Wong P-N, Sin H-K, et al. Risk factors and clinical course of hungry bone syndrome after total parathyroidectomy in dialysis patients with secondary hyperparathyroidism. BMC Nephrology. 2017;18:12. doi:10.1186/s12882-016-0421-5.
  2. Jain N, Reilly RF. Hungry bone syndrome. Curr Opin Nephrol Hyperten 2017 Jul;26(4):250-255. doi: 10.1097/MNH.0000000000000327.
  3. J E Witteveen, S van Thiel, J A Romijn, and N A T Hamdy. THERAPY OF ENDOCRINE DISEASE: Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature. Eur J Endocrinol March 1, 2013 168 R45-R53.
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Dr. C Humphreys

Internal Medicine

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