Clinical features of hypercalcemic crisis due to primary hyperparathyroidism

Jaweher Kechiche; Abir Meherzi; Taieb Ach; Hadjmiled Heyfa Bel; Ghada Saad; Jihen Houas; Omri Malika El; Mouna Bellakhdher; Monia Ghammem; El Abed Yosra Hasni; Wassin Kermani; Mohamed Abdelkefi

doi:10.1530/endoabs.110.EP679

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Endocrine Abstracts (2025) 110 EP679 | DOI: 10.1530/endoabs.110.EP679

ECEESPE2025 ePoster Presentations Environmental Endocrinology (23 abstracts)

Clinical features of hypercalcemic crisis due to primary hyperparathyroidism

Jaweher Kechiche ¹ , Abir Meherzi ¹ , Taieb Ach ² , Heyfa Bel Hadjmiled ¹ , Ghada Saad ² , Jihen Houas ¹ , Malika El Omri ¹ , Mouna Bellakhdher ¹ , Monia Ghammem ¹ , Yosra Hasni El Abed ² , Wassin Kermani ¹ & Mohamed Abdelkefi ¹

Author affiliations

¹Farhat Hached University Hospital, ENT Head and Neck Surgery, Sousse, Tunisia; ²Farhat Hached University Hospital, Endocrinology Departement, Sousse, Tunisia

JOINT3728

Introduction: Primary hyperparathyroidism is a hypercalcemic metabolic disorder related to high or inappropriately normal levels of PTH. A hypercalcemic crisis. Hypercalcemic crisis, also known as parathyrotoxicosis, hyperparathyroid crisis, or parathyroid storm, is a rare but serious complication of primary hyperparathyroidism, occurring in approximately 1.6–6.7% of cases. It may have a potentially fatal course, with a mortality rate reaching up to 7%. The only cutrative treatment was the surgical removal of the parathyroid lesion. Medical management, consisting of aggressive hydration, diuretics, bisphosphonates, and calcitonin, can be used as a bridge therapy for surgery. The aim of this study was to assess clinical features of hypercalcemic crisis in primary hyperparathyroidism.

Materials and methods: This is a retrospective study conducted from January 2010 to December 2023, including all patients admitted and treated for primary hyperparathyroidism. Patients were divided into two groups: those with primary hyperparathyroidism associated with critical hypercalcemic crisis and those without hypercalcemic crisis

Results: During the study period, 80 patients were hosaitlized for primary hyperparathyroidism. Among them, 7 patients had calcium levels exceeding 3.5 mmol/dL, and 5 of these patients had critical symptoms of hypercalcmic crisis (6.25%). Polyuria and polydipsia occurred in three patients, one had acute renal injury, needed hemodialysis. Confusion or lethargy occurred in two patients, while nausea and vomiting affected all patients. One patient had acue pancreatitis (balthazar stage c). Their mean calcium level was 4.43 mmol/dL was statistically higher than the rest of cohort. Mean intact PTH value was 905.8 ng/mL. There was no differnce in preoperative imaging thechniques carried out for localization. they were treated with hydration, diuretics, and bisphosphonates. Four of them responded well to the medication. The remaining patient showed no clinical or laboratory improvement and underwent prompt parathyroidectomy. Based on the histopathological exams, the mean hyper-functional parathyroid gland size was 30,36 mm. adenoma wa observed in 4 patients and double adenoma in one case.

Conclusions: Hypercalcemic crisis is a rare but life-threatening complication of primary hyperparathyroidism that requires prompt diagnosis and management. Medical treatment, including hydration, diuretics, bisphosphonates, and calcitonin, can stabilize patients temporarily, but surgical resection remains the definitive treatment. Early identification of hypercalcemic crisis and the appropriate surgical intervention can significantly improve patient outcomes.