{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:15:11Z","timestamp":1790054111451,"version":"4.0.1"},"reference-count":14,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,6,28]]},"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:p>A woman in her mid-50s with IgA nephropathy, sarcoidosis and steroid-induced diabetes mellitus presented with generalised paraesthesia and spontaneous tetany. She had received denosumab 60\u2009mg subcutaneously 8 weeks previously for parathyroid hormone independent hypercalcaemia.<\/jats:p>\n               <jats:p>At admission, she had severe hypocalcaemia (5\u2009mg\/dL), hypophosphataemia (1.9\u2009mg\/dL), hypomagnesaemia (1.4\u2009mg\/dL) and elevated serum creatinine (1.48\u2009mg\/dL) with prolonged QTc (corrected QT interval) on electrocardiograph. She initially received intravenous calcium and magnesium followed by oral calcium carbonate and calcitriol. Her prednisolone dose was tapered to 5\u2009mg\/day. Evaluation showed secondary hyperparathyroidism (1474\u2009pg\/mL) and elevated 1,25-dihydroxy vitamin D (195\u2009pg\/mL). After 1\u2009week of oral calcium carbonate (3000\u2009mg\/day) and calcitriol (1.5\u2009\u00b5g\/day), she achieved normocalcaemia (8.1\u2009mg\/dL).<\/jats:p>\n               <jats:p>To conclude, denosumab for hypercalcaemia with renal insufficiency causes prolonged severe symptomatic hypocalcaemia and hypophosphataemia mimicking hungry bone syndrome. It is important to periodically monitor for hypocalcaemia after denosumab.<\/jats:p>","DOI":"10.1136\/bcr-2022-250647","type":"journal-article","created":{"date-parts":[[2022,7,8]],"date-time":"2022-07-08T10:35:21Z","timestamp":1657276521000},"page":"e250647","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Hungry bone syndrome like presentation following single-dose denosumab for hypercalcaemia secondary to sarcoidosis with IgA nephropathy"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8971-0137","authenticated-orcid":false,"given":"Amit","family":"Nachankar","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Army Hospital Research and Referral, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Katyal","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Army Hospital Research and Referral, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naresh","family":"Bansal","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Army Hospital Research and Referral, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alka","family":"Bishnoi","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Army Hospital Research and Referral, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,7,8]]},"reference":[{"key":"2025082723092186000_15.7.e250647.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0809493"},{"key":"2025082723092186000_15.7.e250647.2","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.1613"},{"key":"2025082723092186000_15.7.e250647.3","first-page":"e210","article-title":"A dramatic response to denosumab: protracted hypocalcemia related to human T-cell lymphotropic virus type 1-associated adult T-cell leukemia\/lymphoma","volume":"5","author":"Japp","year":"2019","journal-title":"AACE Clin Case Rep"},{"key":"2025082723092186000_15.7.e250647.4","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.9734\/BJMMR\/2013\/2989","article-title":"Severe symptomatic hypocalcemia after denosumab administration in an end-stage renal disease patient on peritoneal dialysis with controlled secondary hyperparathyroidism","volume":"3","author":"Agarwal","year":"2013","journal-title":"Br J Med Med Res"},{"key":"2025082723092186000_15.7.e250647.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2013.04.012"},{"key":"2025082723092186000_15.7.e250647.6","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-05-1933"},{"key":"2025082723092186000_15.7.e250647.7","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/S2213-8587(17)30138-9","article-title":"10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised freedom trial and open-label extension","volume":"5","author":"Bone","year":"2017","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2025082723092186000_15.7.e250647.8","first-page":"e82","article-title":"Severe, prolonged, DENOSUMAB-INDUCED hypocalcemia with recovery after 111 days of high-dose calcium supplementation","volume":"5","author":"McCaleb","year":"2019","journal-title":"AACE Clin Case Rep"},{"key":"2025082723092186000_15.7.e250647.9","first-page":"1","article-title":"Denosumab-induced severe hypocalcaemia in chronic kidney disease","volume":"2018","author":"Jalleh","year":"2018","journal-title":"Case Rep Nephrol"},{"key":"2025082723092186000_15.7.e250647.10","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M110.101964"},{"key":"2025082723092186000_15.7.e250647.11","unstructured":"Cartwright C , Anastasopoulou C . 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