Hyperparathyroid crisis: Characteristics and outcomes - 07/03/23

Doi : 10.1016/j.amjsurg.2022.10.028

Adam Muntaser ^a, Angela Thelen ^b,^f, Ashwini R. Sehgal ^c,^d,^e,^f, Christopher R. McHenry ^b,^f,^⁎
^a Northeast Ohio Medical University, USA
^b Department of Surgery, USA
^c Medicine, USA
^d Rammelkamp Center for Research, USA
^e Center for Reducing Health Disparities, MetroHealth Medical Center, USA
^f Case Western Reserve University School of Medcine, Cleveland, OH, USA

^∗Corresponding Author: Case Western Reserve University, Division of General Surgery, MetroHealth Medical Center, H-918, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA.Case Western Reserve UniversityDivision of General SurgeryMetroHealth Medical Center, H-9182500 MetroHealth DriveClevelandOH44109USA

Abstract

Background

Hyperparathyroid crisis (HPTC) is a potentially lethal condition characterized by severe symptomatic hypercalcemia with calcium levels ≥14 mg/dl. We sought to determine the rate of HPTC and how it differs from hyperparathyroidism (HPT) without crisis (HPTWC).

Methods

A retrospective review of patients with surgically treated HPT from 1990 to 2022 was completed.

Results

HPTC occurred in 18 (2.4%) of 783 with primary HPT. Patients with HPTC had higher preoperative calcium and parathyroid hormone levels, lower postoperative calcium levels, larger gland weights and higher rates of ectopic glands, carcinoma, recurrence and mortality compared to patients with HPTWC (all p < 0.05).

Conclusions

HPTC is a rare condition manifested by severe HPT that is associated with a higher rate of recurrence and mortality compared to HPTWC. HPTC is associated with larger parathyroid glands that are more often ectopic and malignant.

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Graphical abstract

Image 1

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Highlights

•	Hyperparathyroid crisis is rare, occurring in 2.4% of hyperparathyroidism patients.
•	Manifested by more severe primary hyperparathyroidism with larger glands.
•	Parathyroid glands more often ectopic and malignant.
•	Higher rate of recurrence and mortality than hyperparathyroidism without crisis.

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Keywords : Hyperparathyroid crisis, Hypercalcemic crisis, Primary hyperparathyroidism

Abbreviations : HPTC, HPT, HPTWC