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- Starker, Lee FUppsala universitet,Experimentell kirurgi,Department of Surgery, Yale University School of Medicine, New Haven, CT, USA (author)
Clinical and histopathological characteristics of hyperparathyroidism-induced hypercalcemic crisis
- Article/chapterEnglish2011
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- 2010-11-02
- Springer Science and Business Media LLC,2011
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- LIBRIS-ID:oai:DiVA.org:uu-197676
- https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-197676URI
- https://doi.org/10.1007/s00268-010-0840-6DOI
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- Language:English
- Summary in:English
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- BACKGROUND:The clinical and pathological characteristics of hyperparathyroidism-induced hypercalcemic crisis (HIHC) are incompletely described. The present study was designed to elucidate the nature and effects of HIHC in patients undergoing parathyroidectomy in our unit.METHODS:A prospective database of 1,754 consecutive patients with primary hyperparathyroidism (PHPT) who underwent parathyroidectomy from 1991-2009 identified 67 (41 women) patients presenting with HIHC. Hyperparathyroidism-induced hypercalcemic crisis was defined as symptoms and signs of acute calcium intoxication with a concomitant total albumin corrected calcium level>13.5 mg/dl (range: 8.8-10.2 mg/dl). Clinical and pathological characteristics were evaluated. Data are expressed as mean±SEM.RESULTS:Mean age at presentation was 56.7±2.2 years. Twenty-four of 67 patients (35%) required preoperative in-hospital management. Of these, all were treated with saline resuscitation, whereas 20/24 (83%) were treated pharmacologically. Neurocognitive derangements and nephrolithiasis with associated hematuria were the most common presenting symptoms and signs. Preoperative serum calcium and the intact parathyroid hormone level (PTH) were 14.0±0.19 mg/dl and 393±43 pg/ml (reference range: 12-65 pg/ml), respectively. Minimally invasive parathyroidectomy under local cervical block was performed in 28/67 patients (42%); the remainder underwent standard cervical exploration. All patients had postoperative normalization of serum calcium and intact PTH. Hyperparathyroidism-induced hypercalcemic crisis was due to parathyroid carcinoma in 3/67 patients (4.5%), whereas the remainder of patients displayed a single parathyroid adenoma (n=57) or multiglandular hyperplasia (n=7). Histopathological evaluation from HIHC patients revealed a chief cell microcystic pattern in 15/21 (71.4%) of examined parathyroid tumors.CONCLUSIONS:Hyperparathyroidism-induced hypercalcemic crisis is most commonly due to a single parathyroid adenoma, often associated with a microcystic histopathological pattern. The condition is optimally managed with saline hydration and urgent parathyroidectomy.
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- Björklund, PeymanUppsala universitet,Experimentell kirurgi(Swepub:uu)pebjo957 (author)
- Theoharis, Constantine (author)
- Long, William D (author)
- Carling, Tobias (author)
- Udelsman, Robert (author)
- Uppsala universitetExperimentell kirurgi (creator_code:org_t)
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- In:World Journal of Surgery: Springer Science and Business Media LLC35:2, s. 331-3350364-23131432-2323
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