Posttraumatic parathyroid crisis and severe hypercalcemia treated with intravenous bisphosphonate (APD). Case report

Severe acute hypercalcemia (4.03 mmol/l) developed in a 50 years old woman after head and intraabdominal trauma (and splenectomy). After failure to correct the calcium levels by intravenous saline, furosemide, steroids and calcitonin, two hemodialyses were performed; definitive control of hypercalcemia was obtained by intravenous (3-amino-1-hydroxypropylidene)-1.1-bisphosphonic acid (APD). APD is a new drug analog of pyrophosphate; its main property is to block bone resorption, irrespective of its stimulus. As suspected by clinical and laboratory data and confirmed by arteriographic findings, surgery and pathologic examination, the underlying pathology was a mild primary hyperparathyroidism which was acutely worsened (parathyroid crisis) in the course of the trauma. Definitive treatment consisted of the removal of the adenoma responsible of the hyperparathyroidism.