Hypercalcaemic crisis due to primary hyperparathyroidism - A systematic literature review and case report

Angela Gurrado, Giuseppe Piccinni, Germana Lissidini, Pasquale Di Fronzo, Francesco Vittore, Mario Testini

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Hypercalcaemic crisis is an uncommon and potentially life-threatening manifestation of primary hyperparathyroidism, and it is associated with rapid deterioration of the central nervous system, and cardiac, gastrointestinal, and renal function. We present the case of a 76 year-old man in a sudden coma due to hypercalcaemic crisis as a first manifestation of primary hyperparathyroidism. At first, the patient was treated conservatively, his mental status gradually improved in the next three days. On the ninth day after the initiation of therapy, a minimally invasive radio-guided parathyroidectomy was performed. Histologically, the tumour consisted of densely arranged chief cells immunohistochemically positive for PTH antigens, suggesting adenoma. Calcaemia level and PTH were normalised in the immediate postoperative period. A systematic review was performed by consulting PubMed MEDLINE for publications from 1958 to 2011. This review found a total of 499 reported cases of hypercalcaemic crisis due to primary hyperparathyroidism. Manifestations are neurological alterations, and cardiac, renal and gastrointestinal dysfunctions associated with markedly elevated serum calcium and parathyroid hormone levels. The most frequent histology is the parathyroid adenoma. In untreated cases, mortality is 100%. Despite advances in its management, the mortality rate is still 93.5% in patients treated only conservatively. Medical therapy followed by expeditious parathyroidectomy should be considered as the treatment of choice for patients affected by hypercalcaemic crisis due to a primary hyperparathyroidism.

Original languageEnglish
Pages (from-to)494-502
Number of pages9
JournalEndokrynologia Polska
Volume63
Issue number6
Publication statusPublished - 2012

Fingerprint

Primary Hyperparathyroidism
Parathyroidectomy
Kidney
Parathyroid Neoplasms
Mortality
Hypercalcemia
Coma
Neurologic Manifestations
Parathyroid Hormone
Radio
Postoperative Period
PubMed
MEDLINE
Adenoma
Publications
Histology
Therapeutics
Central Nervous System
Calcium
Antigens

Keywords

  • Hypercalcaemia
  • Hypercalcaemic crisis
  • Hyperparathyroidism
  • Parathyroid

ASJC Scopus subject areas

  • Endocrinology

Cite this

Gurrado, A., Piccinni, G., Lissidini, G., Di Fronzo, P., Vittore, F., & Testini, M. (2012). Hypercalcaemic crisis due to primary hyperparathyroidism - A systematic literature review and case report. Endokrynologia Polska, 63(6), 494-502.

Hypercalcaemic crisis due to primary hyperparathyroidism - A systematic literature review and case report. / Gurrado, Angela; Piccinni, Giuseppe; Lissidini, Germana; Di Fronzo, Pasquale; Vittore, Francesco; Testini, Mario.

In: Endokrynologia Polska, Vol. 63, No. 6, 2012, p. 494-502.

Research output: Contribution to journalArticle

Gurrado, A, Piccinni, G, Lissidini, G, Di Fronzo, P, Vittore, F & Testini, M 2012, 'Hypercalcaemic crisis due to primary hyperparathyroidism - A systematic literature review and case report', Endokrynologia Polska, vol. 63, no. 6, pp. 494-502.
Gurrado, Angela ; Piccinni, Giuseppe ; Lissidini, Germana ; Di Fronzo, Pasquale ; Vittore, Francesco ; Testini, Mario. / Hypercalcaemic crisis due to primary hyperparathyroidism - A systematic literature review and case report. In: Endokrynologia Polska. 2012 ; Vol. 63, No. 6. pp. 494-502.
@article{fc4a1df7118b4e5eb7c15dd437ec39c2,
title = "Hypercalcaemic crisis due to primary hyperparathyroidism - A systematic literature review and case report",
abstract = "Hypercalcaemic crisis is an uncommon and potentially life-threatening manifestation of primary hyperparathyroidism, and it is associated with rapid deterioration of the central nervous system, and cardiac, gastrointestinal, and renal function. We present the case of a 76 year-old man in a sudden coma due to hypercalcaemic crisis as a first manifestation of primary hyperparathyroidism. At first, the patient was treated conservatively, his mental status gradually improved in the next three days. On the ninth day after the initiation of therapy, a minimally invasive radio-guided parathyroidectomy was performed. Histologically, the tumour consisted of densely arranged chief cells immunohistochemically positive for PTH antigens, suggesting adenoma. Calcaemia level and PTH were normalised in the immediate postoperative period. A systematic review was performed by consulting PubMed MEDLINE for publications from 1958 to 2011. This review found a total of 499 reported cases of hypercalcaemic crisis due to primary hyperparathyroidism. Manifestations are neurological alterations, and cardiac, renal and gastrointestinal dysfunctions associated with markedly elevated serum calcium and parathyroid hormone levels. The most frequent histology is the parathyroid adenoma. In untreated cases, mortality is 100{\%}. Despite advances in its management, the mortality rate is still 93.5{\%} in patients treated only conservatively. Medical therapy followed by expeditious parathyroidectomy should be considered as the treatment of choice for patients affected by hypercalcaemic crisis due to a primary hyperparathyroidism.",
keywords = "Hypercalcaemia, Hypercalcaemic crisis, Hyperparathyroidism, Parathyroid",
author = "Angela Gurrado and Giuseppe Piccinni and Germana Lissidini and {Di Fronzo}, Pasquale and Francesco Vittore and Mario Testini",
year = "2012",
language = "English",
volume = "63",
pages = "494--502",
journal = "Endokrynologia Polska",
issn = "0423-104X",
publisher = "Via Medica",
number = "6",

}

TY - JOUR

T1 - Hypercalcaemic crisis due to primary hyperparathyroidism - A systematic literature review and case report

AU - Gurrado, Angela

AU - Piccinni, Giuseppe

AU - Lissidini, Germana

AU - Di Fronzo, Pasquale

AU - Vittore, Francesco

AU - Testini, Mario

PY - 2012

Y1 - 2012

N2 - Hypercalcaemic crisis is an uncommon and potentially life-threatening manifestation of primary hyperparathyroidism, and it is associated with rapid deterioration of the central nervous system, and cardiac, gastrointestinal, and renal function. We present the case of a 76 year-old man in a sudden coma due to hypercalcaemic crisis as a first manifestation of primary hyperparathyroidism. At first, the patient was treated conservatively, his mental status gradually improved in the next three days. On the ninth day after the initiation of therapy, a minimally invasive radio-guided parathyroidectomy was performed. Histologically, the tumour consisted of densely arranged chief cells immunohistochemically positive for PTH antigens, suggesting adenoma. Calcaemia level and PTH were normalised in the immediate postoperative period. A systematic review was performed by consulting PubMed MEDLINE for publications from 1958 to 2011. This review found a total of 499 reported cases of hypercalcaemic crisis due to primary hyperparathyroidism. Manifestations are neurological alterations, and cardiac, renal and gastrointestinal dysfunctions associated with markedly elevated serum calcium and parathyroid hormone levels. The most frequent histology is the parathyroid adenoma. In untreated cases, mortality is 100%. Despite advances in its management, the mortality rate is still 93.5% in patients treated only conservatively. Medical therapy followed by expeditious parathyroidectomy should be considered as the treatment of choice for patients affected by hypercalcaemic crisis due to a primary hyperparathyroidism.

AB - Hypercalcaemic crisis is an uncommon and potentially life-threatening manifestation of primary hyperparathyroidism, and it is associated with rapid deterioration of the central nervous system, and cardiac, gastrointestinal, and renal function. We present the case of a 76 year-old man in a sudden coma due to hypercalcaemic crisis as a first manifestation of primary hyperparathyroidism. At first, the patient was treated conservatively, his mental status gradually improved in the next three days. On the ninth day after the initiation of therapy, a minimally invasive radio-guided parathyroidectomy was performed. Histologically, the tumour consisted of densely arranged chief cells immunohistochemically positive for PTH antigens, suggesting adenoma. Calcaemia level and PTH were normalised in the immediate postoperative period. A systematic review was performed by consulting PubMed MEDLINE for publications from 1958 to 2011. This review found a total of 499 reported cases of hypercalcaemic crisis due to primary hyperparathyroidism. Manifestations are neurological alterations, and cardiac, renal and gastrointestinal dysfunctions associated with markedly elevated serum calcium and parathyroid hormone levels. The most frequent histology is the parathyroid adenoma. In untreated cases, mortality is 100%. Despite advances in its management, the mortality rate is still 93.5% in patients treated only conservatively. Medical therapy followed by expeditious parathyroidectomy should be considered as the treatment of choice for patients affected by hypercalcaemic crisis due to a primary hyperparathyroidism.

KW - Hypercalcaemia

KW - Hypercalcaemic crisis

KW - Hyperparathyroidism

KW - Parathyroid

UR - http://www.scopus.com/inward/record.url?scp=84876198956&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84876198956&partnerID=8YFLogxK

M3 - Article

VL - 63

SP - 494

EP - 502

JO - Endokrynologia Polska

JF - Endokrynologia Polska

SN - 0423-104X

IS - 6

ER -