Anesthetic considerations in hyperparathyroid crisis: A case report.

Area of Science:

• Endocrinology
• Anesthesiology
• Critical Care Medicine

Background:

• Hyperparathyroid crisis is a rare but severe complication of hypercalcemia.
• Parathyroidectomy is the definitive treatment, but perioperative anesthetic management presents significant challenges.

Observation:

• A 48-year-old woman presented with severe hypercalcemia (5.21 mmol/L), elevated parathyroid hormone (>5000 pg/mL), and multiple organ dysfunction including acute kidney and liver injury, rhabdomyolysis, infection, and shock.
• Initial medical management failed, necessitating urgent parathyroidectomy under general anesthesia.

Findings:

• Meticulous anesthetic management, including aggressive fluid resuscitation, circulatory support, and temperature regulation, was crucial.
• Successful tumor resection led to gradual improvement of vital signs and patient survival.

Implications:

• Thorough preoperative evaluation is essential for patients with hyperparathyroid crisis.
• Anesthesiologists must address challenges like difficult airway, fluid shifts, organ dysfunction, and hypercoagulability.
• Close postoperative monitoring of calcium levels and timely supplementation are vital to prevent complications.