Parathyroid surgery for hypercalcaemic crisis in primary hyperparathyroidism-a retrospective study

Hypercalcaemic crisis (HCC) is a serious and potentially life-threatening complication of increased serum calcium concentration. It is most commonly due to primary hyperparathyroidism (PHPT), from a parathyroid hormone (PTH) secreting tumour. This paper looks at factors affecting outcomes of parathyroid surgeries in HCC patients.

Data were collected retrospectively including demographics, biochemistry and histology results, details of localisation studies, time from referral to surgery, disease related admissions, length of hospital stay. Statistical analysis was performed between the mild (2.6-2.9 mmol/L), moderate (3-3.5 mmol/L) and severe (>3.5 mmol/L) hypercalcaemia (HC) groups. Operative cure was analysed as a drop of post-operative PTH and normalisation of adjusted calcium after 6 months.

A total of 175 patients (132 female, 43 male) were identified to have undergone parathyroid surgeries between 2018 and 2025. Seventy-three percent (n=128) of patients had mild HC, 23% (n=40) had moderate HC and 4% had severe HC (n=7). Preoperative adjusted calcium and preoperative PTH concentrations were statistically significantly higher in the severe HC group (P<0.001). The weight of gland in the severe hypercalcaemic group of patients was statistically significantly higher (P<0.001) with a mean of 10.28 g (range, 0.172-52 g). Nine percent (n=11) of patients with mild, 25% (n=10) with moderate, and 100% of patients (n=7) with severe HC had disease related admission (P<0.001).

The statistically significant post-operative drop in PTH and adjusted calcium gave us a success rate of 93% overall, which again is broadly in line with current guidelines and with no statistically significant difference in operative success with the patients presenting level of HC. This study intends to raise awareness for service providers to understand the need to prioritise the surgical treatment of this benign but potentially fatal condition.