Hypercalcemic crisis due to primary hyperparathyroidism

• Published in: Deutsche medizinische Wochenschrift (1946) Vol. 133; no. 50; p. 2639
• Main Authors: Guthoff, M, Georges, G, Wehrmann, M, Teichmann, R, Gröne, E, Risler, T, Häring, H-U, Müssig, K
• Format: Journal Article
• Language: German
• Published: Germany 01.12.2008
• Subjects: Abdominal Pain; Acute Kidney Injury - complications; Acute Kidney Injury - etiology; Acute Kidney Injury - therapy; Adenoma - complications; Adenoma - diagnostic imaging; Adenoma - surgery; Bone Density Conservation Agents - therapeutic use; Diagnosis, Differential; Diphosphonates - therapeutic use; Disorders of Excessive Somnolence; Female; Fluid Therapy; Humans; Hypercalcemia - diagnosis; Hypercalcemia - etiology; Hypercalcemia - therapy; Hyperparathyroidism - complications; Hyperparathyroidism - etiology; Hyperparathyroidism - therapy; Middle Aged; Parathyroid Neoplasms - complications; Parathyroid Neoplasms - diagnostic imaging; Parathyroid Neoplasms - surgery; Renal Dialysis; Tachycardia; Ultrasonography
• ISSN: 1439-4413
• DOI: 10.1055/s-0028-1105861

A 54-year-old female patient presented with increasing somnolence since two days. Furthermore, the patient reported left-sided mid-abdominal pain and obstipation for one week. Immediately prior to admission, the patient had returned from a 14-day beach holiday on the Azores. Physical examination of the somnolent patient revealed a sun-tanned skin, signs of exsiccosis, and tachycardia with 116 beats per minute. Laboratory studies showed marked hypercalcemia due to primary hyperparathyroidism and acute renal failure. Neck ultrasonography revealed a hypoechogenic, 5.8 x 3.5 x 3.1 cm-measuring mass behind the lower pole of the right thyroid lobe. Serum calcium levels significantly decreased after immediate rehydration, bisphosphonate administration, and continuous hemodialysis that was also indicated because of acute renal failure with anuria. After knowledge of increased parathormone levels the patient underwent rapidly resection of the parathyroid adenoma which was histologically confirmed. Hypercalcemic crisis is often associated with acute renal failure due to calcium-induced polyuria.