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Life-threatening tertiary hyperparathyroidism in the critically ill.
Christopher C Jeffries1, Anna M Ledgerwood, Charles E Lucas
1Department of Surgery, Wayne State University, 4201 St. Antoine, Suite 2V, Detroit, MI 48201, USA.
American Journal of Surgery
|March 29, 2005
Summary
A new syndrome of tertiary hyperparathyroidism (THP) in critically ill patients with multiple organ failure (MOF) is identified. Early diagnosis and bisphosphonate treatment are crucial to prevent life-threatening cardiac events like bradycardia.
Area of Science:
- Critical care medicine
- Endocrinology
- Nephrology
Background:
- Tertiary hyperparathyroidism (THP) is commonly seen post-renal transplant.
- This report details THP in patients recovering from multiple organ failure (MOF) with acute oliguric renal failure (AORF).
Observation:
- Six patients with MOF and AORF exhibited elevated parathyroid hormone (PTH) levels.
- Increased PTH was noted as early as 3 weeks post-insult and persisted for weeks.
Findings:
- Elevated calcium levels caused recurrent bradycardia, sometimes leading to asystole.
- This hypercalcemia-induced bradycardia was resistant to standard treatments.
- Bisphosphonate therapy was effective but required repeat doses until organ function normalized.
Implications:
- A novel syndrome of life-threatening THP in critical illness is described.
- This condition may be underdiagnosed in critical care settings.
- Prophylactic bisphosphonate treatment could prevent severe cardiac arrhythmias.