Hypercalcemic Crisis in the Era of Targeted Parathyroidectomy

Beck, William C.; Lew, John I.; Solórzano, Carmen C.

doi:10.1016/j.jss.2011.04.010

Cited by 19 publications

(24 citation statements)

References 15 publications

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“…Thus, the cohort of patients with HC was similar to the general population of patients with PHPT, though conventional wisdom would suggest that HC is likely to be caused by single adenoma. This finding is in contrast to the series reported by Beck and colleagues where there were equivalent rates of multi-gland disease in crisis and non-crisis patients (12). However, for an accurate comparison, it is important to note that while our study only included patients with calcium levels of 12 mg/dL or higher, their study included all patients being treated for hyperparathyroidism.…”

Section: Discussioncontrasting

confidence: 99%

“…These differences in study design make direct comparisons challenging. Similar to Beck and colleagues, cure rates for those with and without HC were comparable indicating that despite variation in the proportion of multi-gland disease, surgery remains an effective treatment for these patients (12). Nevertheless, in the absence of the expected decrease in intraoperative PTH during a minimally invasive approach, we encourage a low threshold for four-gland exploration in patients with HC, given the proven severity of the symptoms and the importance of providing a cure with the first surgery.…”

Section: Discussionsupporting

confidence: 70%

“…Most previous studies use an arbitrary plasma calcium level to define HC (2, 6, 12–15). Our study took a different approach, allowing us to evaluate the association of plasma calcium levels and the risk of HC.…”

Section: Discussionmentioning

confidence: 99%

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Assessing the risk of hypercalcemic crisis in patients with primary hyperparathyroidism

Lowell

Bushman

Wang

et al. 2017

Journal of Surgical Research

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Background Hypercalcemic crisis (HC) is a potentially life-threatening manifestation of primary hyperparathyroidism (PHPT). This study aims to identify patients with PHPT at greatest risk for developing HC. Methods This retrospective cohort study included patients with a pre-operative calcium of at least 12mg/dL undergoing initial parathyroidectomy for PHPT from 11/2000–03/2016. We compared those with HC, defined as needing hospitalization for hypercalcemia, to those without HC. Results The study cohort included 29(15.8%) with HC and 154(84.2%) without. Demographics and comorbidities were similar between groups. Patients with HC were more likely to have a history of kidney stones (31.0% vs. 14.3%, P=0.039), higher pre-operative calcium (median 13.8 vs. 12.4mg/dL, P<0.001), higher parathyroid hormone (PTH) (median 318 vs. 160pg/mL, P=0.001), and lower vitamin D (median 16 vs. 26ng/mL, P<0.001) than patients without HC. Cure rates with parathyroidectomy were similar, but nearly double the proportion of patients with HC had multi-gland disease (24.1 vs. 12.3%, P=0.12). In multivariable analysis, higher pre-operative calcium (OR 1.7, 95% CI 1.1–2.5), higher PTH (OR 1.0, 95% CI 1.0–1.0), and kidney stones (OR 3.0, 95% CI 1.1–8.2) were independently associated with HC. A Classification and Regression Tree revealed that 91% of patients with a calcium ≥13.25 mg/dL and a Charlson Comorbidity Index ≥4 developed HC. Conclusions These data indicate that calcium, PTH, and kidney stones are important in predicting who is at greatest risk of HC. The Classification and Regression Tree can further help stratify risk for developing HC and allow surgeons to expedite parathyroidectomy accordingly.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 70%

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Assessing the risk of hypercalcemic crisis in patients with primary hyperparathyroidism

Lowell

Bushman

Wang

et al. 2017

Journal of Surgical Research

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“…These activities should include the preparation of the patient for surgery as soon as possible, with the aim of removing the diseased parathyroid gland as a factor generating hypercalcaemia and the sequence of metabolic disorders resulting from it [16]. A proper preparation of the patient for surgery, safety of anaesthesia, and the effectiveness of the surgical treatment often require interdisciplinary cooperation and combined efforts of an internist, nephrologist, endocrinologist, anaesthesiologist, and surgeon [5,6,15,17,18]. A clinical analysis of our patients indicates that it is not always possible to perform a MIBI parathyroid scintigraphy test, either because of the lack of technical capabilities or, above all, the rapidly worsening condition of the patient with a systematically increasing serum iCa2 + concentration.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of patients with primary hyperparathyroidism with a risk of hypercalcaemic crisis

Buła

Kowalski

Koziołek

et al. 2020

Endokrynologia Polska

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Introduction: The objective of the work was to evaluate the effectiveness of surgical treatment in patients with a high risk of hypercalcaemic crisis due to primary hyperparathyroidism (PHPT) and to determine the best time to undergo surgery. Material and methods and Results: Between 2010 and 2019, 627 patients underwent surgery due to PHPT. Sixty-two patients (9.9%) (47 women and 15 men, aged 28-79 years, average 53.7 years) faced the threat of a parathyroid crisis. In these patients, the average parathyroid hormone (PTH) levels were 774.02 pg/mL (95% CI: 203-1246 pg/mL) and ionised calcium (iCa2+) 1.91 mmol/L (95% CI: 1.70-2.2 mmol/L). The PTH postoperative concentration averaged at 37.86 pg/mL (95% CI: 9.91-42.7 pg/mL) and iCa2 + 1.11 mmol/L (95% CI: 1.07-1.21 mmol/L). Bilateral neck exploration was performed in all patients with the removal of the affected parathyroid gland and biopsies of other parts. Histopathological examination revealed adenoma in 42 cases (67.7%), hyperplasia in 16 (25.7%), and parathyroid cancer in four of the patients (6.6%). Comparison of tests before and after surgery showed a statistically significant decrease in PTH (p < 0.001) and iCa (p < 0.001) in blood serum. Conclusions: A developing hypercalcaemic crisis in the course of hyperparathyroidism is an indication for preoperative intensive medical therapy, along with urgent surgical intervention and removal of diseased parathyroid glands. This type of surgery should be performed as soon as possible, even if there are no imaging tests, only based on an assessment of the general condition of the patient and their serum calcium levels.

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“…This cause an increase in intracellular calcium levels which results in the activation of protein kinase C cascade. This activation causes a hypertrophic process to be initiated on the cardiac myocytes beside some other metabolic effects [13]. In addition to the hypertrophic effect, parathyroid hormones increase the chornotropic effect on cardiac cells and decrease the energy utilization which results in myocardial and valvular calcifications, diastolic dysfunction and cardiac hypertrophy [14].…”

Section: Vol 2 Issue 4 Oct -Dec 2016mentioning

confidence: 99%

Primary Hyperparathyroidism and Cardiac Arrest: Case Report

Mahmood

Mahmood²,

Mohammed³

2016

IJCR

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Hyperparathyroidism is a common endocrine disorder characterized by hypersecretion of parathyroid hormones due to abnormal activity of one or more parathyroid glands. Several cardiac abnormalities have been reported due to hyperparathyroidism. In this case report, a case of cardiac arrest due to hyperparathyroidism and hypercalcemia is presented and discussed. A female patient, 73 years old, was admitted to surgical ward (SICU) with malignant goiter extending to the retrosternum. She was a known case of hyperparathyroidism and hypercalcemia. After the operation, the patient was shifted to SICU for further management. Suddenly, the patient had sudden cardiac arrest and was successfully resuscitated within 2 minutes. The ECG showed a new Right Bundle Branch Block (RBBB) changes. Patient remained on ventilator, not obeying commands, and opened her eyes spontaneously with cough reflex. A week after, percutaneous tracheostomy was performed, and patient became hemodynamically stable, weaned from ventilator and allowed to breathe spontaneously. Although cardiac arrest is a rare complication, it should be expected by health care providers when dealing with patients with hyperparathyroidism and hypercalcemia.

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Hypercalcemic Crisis in the Era of Targeted Parathyroidectomy

Cited by 19 publications

References 15 publications

Assessing the risk of hypercalcemic crisis in patients with primary hyperparathyroidism

Assessing the risk of hypercalcemic crisis in patients with primary hyperparathyroidism

Surgical treatment of patients with primary hyperparathyroidism with a risk of hypercalcaemic crisis

Primary Hyperparathyroidism and Cardiac Arrest: Case Report

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