Endocrine Abstracts

Introduction: Hypercalcemia crisis constitutes a metabolic emergency associated with high mortality. Occasionally, it can be the mode of revelation of primary hyperparathyroidism.

Objectives: To analyze the clinical characteristics of patients presenting with hypercalcemia crisis revealing primary hyperparathyroidism. And to describe the complications and evolution of the disease.

Patients and methods: Retrospective descriptive study of 32 cases of primary hyperparathyroidism collected at the Department of Endocrinology and Metabolic Diseases of Ibn Rochd University Hospital over a 4-year period from January 2020 to December 2023. We included 9 cases of hypercalcemia crisis revealing primary hyperparathyroidism.

Results: In our series, there was a female predominance (5 women/4 men) with an average age of 40.7 years (10–78). The mean value of serum calcium was 154.7 mg/l (140-184), and PTH was 1270 pg/ml (117–2500). The discovery of hypercalcemia crisis was either incidental in 3 patients or associated with symptoms such as bone pain in 3 patients, renal colic in one patient, and vomiting in a patient who was 24 weeks pregnant. The topographic diagnosis was established by MIBI scintigraphy in 6 patients, cervical MRI in 2 patients, and ultrasound in one patient. The average size of the nodules was 23 mm. Among the bone complications, 4 patients experienced fractures (patella, tibia, and humerus), bone densitometry revealed osteoporosis in 7 patients, renal ultrasound identified kidney stones in 4 patients, one patient developed a cardiac arrhythmia, and one patient presented with pancreatitis. The treatment included reanimation measures for all patients with dialysis for some, followed by parathyroid surgery in 8 patients, with one patient refusing surgery. The histological examination revealed 7 parathyroid adenomas and 1 carcinoma. In the postoperative period, 3 patients experienced hypocalcemia.

Conclusion: Hypercalcemia crisis is an unusual mode of primary hyperparathyroidism revelation, indicative of a longstanding form with delayed diagnosis. Its management must be rapid and effective as the prognosis is at stake.