[Clinical characteristics and course of severe hypercalcemia caused by primary hyperparathyroidism in surgically...

To describe presentation, diagnosis, management and outcome of severe hypercalcemia due to primary hyperparathyroidism in a series of patients.

Clinical characteristics, presentation, diagnosis, acute preoperative medical management, surgical findings and strategy, short outcome and complications of a cohort of 21 patients with primary hyperparathyroidism (HPT) and severe hypercalcemia (serum calcium > or = 14 mg/dL) were analyzed. This group was selected from a total of 118 patients who underwent surgery for HPT in the time period.

Mean age was 47 +/- 17 years-old and the male:female ratio was 4:17. A total of 95% of patients presented one or more symptoms related to hypercalcemia while 62% had an abnormal EKG and 76% also had radiological abnormalities. All patients received intense hydration often associated to diuretics. Uniglandular disease was found in 13 patients, multiglandular involvement was identified in 4 and parathyroid carcinoma was documented in other 4. Normalization of the calcemia was achieved in all patients with benign disease.

Severe hypercalcemia was relatively frequent in our patients with HPT. Most patients were symptomatic and presented radiological or cardiac abnormalities. Surgical normalization of the calcemia was achieved in all patients with benign disease.