Management of hyperparathyroid-induced hypercalcaemic crisis with intracardiac thrombi

A 29-year-old previously healthy patient presented with a hyperparathyroid-induced hypercalcaemic crisis refractory to conventional therapy. The patient developed ventricular fibrillation and subsequently required emergency parathyroidectomy and extracorporeal membrane oxygenation support. Extensive intracardiac and pulmonary trunk thrombi were identified soon after the commencement of extracorporeal membrane oxygenation, despite full anticoagulation. In this report we highlight the non-specific presentations of hypercalcaemia which may lead to delayed diagnosis, and discuss the incidence, risk factors and treatment of a hyperparathyroid-induced hypercalcaemic crisis. We emphasise the role of emergency parathyroidectomy as a salvage therapy in medically refractory We consider the likely factors leading to intracardiac thrombi formation in this case, including how hypercalcaemia may have been a contributing factor.