Severe Hypercalcemia Secondary to Primary Hyperparathyroidism

Abstract

Primary hyperparathyroidism is usually asymptomatic or paucisymptomatic, however, in rare cases threatening hypercalcemia is the presenting symptom. The aim of our study is to analyze cases of severe hypercalcemia in primary hyperparathyroidism. Subjects and Methods: 5 patients (3M/2F, mean age = 48 years) with primary hyperparathyroidism (2 carcinomas, 3 adenomas) with serum calcium level ≥ 14 mg/dl. Results: Serum calcium levels varied between 14 and 18 mg/dl and parathormone (PTH) levels between 840 and 1631 pg/ml. Non-specific symptoms such as anorexia, nausea, vomiting, polyuria, dehydration, abdominal pain, weight loss, fatigue, muscular weakness, pruritus, irritability and lethargy were present in all patients. Bone fracture and brown tumors were present in 4 patients. Parathyroid nodule size varied between 20 and 46 mm and was clinically palpable in three patients. All patients received symptomatic treatment of hypercalcemia before parathyroid surgery: rehydration with saline in all cases, hemodialysis in one case and bisphosphonates in three patients. In the postoperative period, all patients had hypocalcaemia, which was severe, requiring high amounts of calcium in two patients. Conclusion: Severe hypercalcemia is a rare but potentially fatal endocrine emergency if unrecognized and untreated. Appropriate diagnosis and adequate management are important to improve its prognosis.