SFEBES2022 Poster Presentations Bone and Calcium (40 abstracts)
Recognition and acute management of parathyroid crisis; early localization and surgery
Ekenechukwu Young 1 , Jeanny Varghese 1 , Richard Bell 1 , Ngai Kong 1 , Praveen Bhathia 1 , Peter Selby 2 , Matthew Jackson 1 , Mariyah Ahmed 1 , Bence Forgacs 2 & Samuel Pulman 1
1Stepping Hill Hospital Stockport NHS Foundation Trust, Stockport, United Kingdom; 2Manchester University NHS Foundation Trust, Manchester, United Kingdom
Background: Parathyroid crisis is a rare presentation with high mortality if unrecognized. Early surgery is curative with rapid symptom resolution and improved outcomes.
Case Report: We describe a case of severe hypercalcaemia due to primary hyperparathyroidism in a 59 year old male who presented with symptoms of lethargy, confusion, reduced appetite, constipation, light headedness and vomiting. Clinical examination was unremarkable. He had normal inflammatory markers. Severe hypercalcaemia of 4. 44 mmol/l was detected with a Parathyroid hormone level of 480 nmol/l. A diagnosis of parathyroid crises was recognised and he was started on intravenous fluid and Pamidronate. He then had haemofiltration in ICU as calcium levels remained refractory to treatment. CT scans of the thorax and abdomen demonstrated an uncharacterized cyst immediately adjacent to the upper thoracic oesophagus with no evidence of malignancy. Ultrasound of the neck and a MIBI subtraction scan failed to localize a definite parathyroid adenoma, however a site of MIBI activity was noted around the area of the cyst, and this was identified with endobronchial ultrasound as a fluid-filled paraoesophagheal cyst, with PTH level >530 pmol/l in the cyst fluid. He was started on Cinacalcet as a bridge to surgery, which also stabilized his calcium levels. Immediate parathyroidectomy was carried out at the site identified on the EBUS. A benign, large cystic parathyroid gland 44 x 19 x 20 mm and weighing 6.04g was excised. His calcium levels remained stable post-operatively and his symptoms resolved.
Discussion: Parathyroid crisis was detected early in this patient and several modalities were employed to lower calcium level. Immediate tumor localization and surgery prevented multi-organ failure and adverse outcomes. We recommend that the BES should consider addition of guidelines to aid early recognition and management of parathyroid crises.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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