Hyperparathyroid Crisis

Abstract

Patients [14] with hyperparathyroid crisis treated at the Massachusetts General Hospital [Boston, Massachusetts, USA] between 1964 and 1978 showed diverse clinical manifestations that were indistinguishable from those in patients with pseudohyperparathyroidism. Their symptoms varied from progressive fatigue, malaise and weakness to those related to the gastrointestinal and urinary tracts. The 1 biochemical alteration commonly found among these patients was the rapid increase in the serum Ca. There was a concomitant rise in the BUN [blood urea N] in 50% of the patients and in the creatinine in 80%. The diagnosis was established by an elevated immunoreactive parathyroid hormone (PTH) level in all 8 patients (100%) who had the radioimmunoassay; by the presence of subperiosteal resorption of the phalanges in 6 of the 8 patients (75%); and in 3 of 4 patients (75%) by the loss of the lamina dura of the teeth. The 12 patients who had surgery all survived; the 2 who did not died. Thirteen patients (93%) had a neoplasm, an adenoma in 12 and a carcinoma in 1. One patient had hyperplasia (7%). Nine patients (64%) received hypocalcemic drug therapy. The serum Ca temporarily fell to 12 mg/100 ml in 5 patients (56%) but failed to budge in 4 (44%). Simultaneous treatment with saline infusion, furosemide and with hypocalcemic drugs over a prolonged period compounded the difficulty at operation by increasing interstitial edema. Prompt surgical intervention is the ideal treatment for hyperparathyroid crisis, preferably within 72 h of the acute onset of symptoms.