Acute Hyperparathyroidism: our experience with 36 cases

Abstract

Objectives: acute hypercalcemia is a serious condition and represents a physician-surgical emergency: the difficulty in setting a precise diagnosis is due to several possibilities that can cause the condition. It is our purpose to critically evaluate the most actual schemes of treatment and the conditions that could favour the appearance of a hypercalcemic acute crisis.

Materials and Methods: A retrospective study was performed considering 1321 patients (638 primary HPT, 683 secondary or tertiary HPT) operated from 1975 to December 2002 for Primary, Secondary and Tertiary HPT.

Results: it should be noticed that out of 638 cases of Primary HPT this syndrome was present in 35 patients (Ca higher than 15 mg/dl): if you compare these cases with the hyperparathyroid population with calcium less than 15 mg/dl it is possible to observe that a double adenoma or a carcinoma were more frequently found in acute HPT, as the cystic appearance of the lesion. The weight of the adenoma and the PTH assay are strictly correlated with the appearance of this syndrome. The mortality rate is also higher (2.8% to 0.1%) than in the hyperparathyroid patient who underwent parathyroidectomy without hypercalcemic crisis.

Conclusion: These characteristics suggest that an early operation is mandatory in the patients in whom such a possibility could be expected, before serious involvement of the cardiovascular, renal or neuromuscular system. We can point out the rarity of this syndrome in Secondary and Tertiary HPT: just one case in Secondary out of 683 patients operated on from 1975 until December 2002.