Normocalcemic Hyperparathyroidism Culminating in Hypercalcemic Crisis

Abstract

Definitive therapy for acute hypercalcemic crises of hyperparathyroidism is surgical removal of all hyperfunctioning parathyroid tissue. Often the hypercalcemic syndrome of intractable nausea and vomiting, somnolence or coma, decreasing urinary flow, progressive azotemia, and cardiac arrhythmias greatly increases the operative risk. The extent of the danger is shown by an overall mortality of about 65%.^1-3 Since the syndrome is directly attributable to the high level of ionized calcium in the serum, clinical improvement depends on reducing the calcium level. Usually this is attempted by increasing calcium excretion or by chelating or complexing calcium ions. However, the former method depends on good urinary output and many times is ineffective because glomerular filtration is almost always very poor in this syndrome. Calcium complexing agents may cause additional renal damage. Although dialysis avoids both of these objections, several authors have concluded that neither peritoneal dialysis nor hemodialysis is helpful in the management