Acute hyperparathyroidism: a surgical emergency

Surviving extreme hypercalcaemia--a case report and review of the literature

We report a case of extreme hypercalcaemia associated with a parathyroid adenoma in a young man. The patient presented with classical symptoms of a hypercalcaemic syndrome, and serum calcium and parathyroid hormone levels were 6.92 mmol L(-1) and 70.2 pmol L(-1) respectively. After stabilizing the patient and reducing the calcium level, a parathyroidectomy was performed. The postoperative course was uneventful with rapidly resolving clinical symptoms. Hypercalcaemic crisis is a rare but life-threatening complication of primary hyperparathyroidism. It should be suspected in acutely ill patients complaining of muscular weakness, gastrointestinal and cerebral symptoms. To reduce mortality, it is essential to correctly diagnose the condition without delay and provide appropriate emergency management correcting hypercalcaemia and dehydration. Successful parathyroidectomy quickly relieves symptoms and prevents recurrence.

Case report: milk-alkali syndrome and pancreatitis

The relation between hypercalcemia and pancreatitis, first described in patients with hyperparathyroidism, is controversial. Other causes of hypercalcemia also have been associated with pancreatitis. In this report, the authors describe a patient with pancreatitis and the milk-alkali syndrome who had the classic triad of hypercalcemia, alkalosis, and renal insufficiency. The authors also review the literature for all the reported cases of pancreatitis associated with hypercalcemia.

Parathyroid carcinoma in a child: unusual presentation with seizures

The second reported case of carcinoma of the parathyroid gland in a child 15 years of age or younger is presented. This case is also remarkable in its extremely unusual presentation with seizures, theorized to be associated with hypercalcemia and/or a negative magnesium balance.

Acute hyperparathyroidism successfully treated by total parathyroidectomy and parathyroid autotransplantation

Acute hyperparathyroidism occurs infrequently and sometimes represents a diagnostic problem in urological patients. We report a case of acute hyperparathyroidism successfully treated by total parathyroidectomy and parathyroid autotransplantation.

Treatment of hypercalcemia

The indications, effectiveness, and adverse effects of the numerous treatment modalities for hypercalcemia are presented. Results of a retrospective chart review of 72 admissions (53 patients) for hypercalcemia-related diseases are presented to emphasize the therapeutic principles that should be applied in the management of these patients. Hydration, forced diuresis, oral phosphates, and glucocorticosteroid drugs are common therapeutic approaches. Combination therapy with glucocorticosteroid drugs, oral phosphates, and forced diuresis is utilized to take advantage of multiple mechanisms of action. Outpatient therapy for hypercalcemia consists primarily of glucocorticosteroid agents and oral phosphates. Most patients are treated if the serum calcium level is greater than or equal to 12 mg/dL. An algorithm is presented to assist the clinician in selecting the most efficacious treatment plan.

Primary hyperparathyroidism: hyperparathyroid crisis

Hyperparathyroid crisis is a rare disease but should be suspected in acutely ill patients complaining of weakness, lethargy, nausea, vomiting, confusion and abdominal pain. Despite the variety of clinical manifestations, the syndrome forms a distinctive pattern which, in the presence of a serum calcium level greater than 16 mg/100 ml, should be recognized. The most difficult problem in diagnosis is the differentiation of hyperparathyroid crisis from ectopic parathyroid hormone-producing tumors. The disease is an endocrine emergency which requires prompt surgery after rapid correction of dehydration and hypercalcemia. The best results are achieved by removing offending parathyroid tissue within 72 hours after the onset of symptoms.

Acute hyperparathyroidism. Clinical, laboratory and ultrastructural findings in a variant of primary hyperparathyroidism

In a series of 6 patients out of 47 cases with extrarenal hyperparathyroidism we investigated the clinical, laboratory and ultrastructural peculiarities of acute hyperparathyroidism. It was found that there are characteristic differences between both entities which, however, are fluid. Clinically more severe were neuromuscular psychiatric and mental signs. In the laboratory parameters PTH determined by radioimmunoassay and calcium were higher whereas hemoglobin was lower. The weights of the adenomas did not differ in both groups and this was also true for light microscopy findings. Electron microscopy revealed accelerated hormone extrusion and autodigestion of retrived membrane material in the cases of acute hyperparathyroidism similar to characteristics of parathyroid cells stimulated by hypocalcemia in tissue culture.

Pancreatitis and hyperparathyroidism

Three patients with acute pancreatitis were found also to have hyperparathyroidism, two of them also formed pancreatic cysts. There appears to be more than an incidental relationship between the two diseases. The importance of serum calcium estimations in patients with pancreatitis is stressed. Theories as to why these diseases co-exist are reviewed.

Problems in acute hyperparathyroidism

The diagnostic and therapeutic problems of acute hyperparathyroidism are discussed on the basis of 4 selected cases. A highly raised serum-calcium level was demonstrated in all 4 cases. Serum-calcium determinations should be undertaken in every case which presents a vague clinical picture. Primary hyperparathyroidism should be treated by operation as soon as the diagnosis has been made, before any other surgical therapy of accompanying disorders is carried out, such therapy being liable to provoke a crisis requiring immediate operation.

Parathyroid adenoma complicated by acute hyperparathyroidism: report of a case with particular regard to ultrastructural findings

Images

Hyperparathyroid crisis associated with pancreatitis

Images