Dialysis for Parathyroid Tumor Crises to Combat Ventricular Arrhythmia Risk: A Report of 2 Cases

A parathyroid crisis is a rare endocrine emergency characterized by life-threatening hypercalcemia, often due to delayed presentations with severe primary hyperparathyroidism. Prompt identification and management are crucial to mitigate potentially fatal complications such as cardiac arrhythmias. We report 2 cases of severe hypercalcemia secondary to parathyroid tumors managed with dialysis prior to definitive surgery. The first involved a 41-year-old man with severe hypercalcemia (serum calcium 20.6 mg/dL [SI: 5.14 mmol/L]) and parathyroid carcinoma, complicated by ventricular arrhythmias requiring cardioversion. Despite aggressive medical therapy, dialysis was initiated, but persistent arrhythmias necessitated emergency surgery. The second case involved a 30-year-old woman with significant hypercalcemia (serum calcium 20.2 mg/dL [SI: 5.04 mmol/L]) and an atypical parathyroid adenoma, who was stabilized preoperatively using continuous dialysis with a low calcium dialysate and regional citrate anticoagulation. Both patients underwent successful parathyroidectomy with subsequent normalization of calcium levels. These cases highlight the critical role of dialysis in stabilizing severe hypercalcemia prior to surgical intervention, particularly when arrhythmia risk is of concern. Given the possibility of cardiac complications, early consideration of dialysis should be considered in the management of parathyroid crisis.