Hyperparathyroidism, hypercalcemia and the otolaryngology head and neck surgeon

Ability to successfully accomplish parathyroid surgery, as well as to understand the pathophysiology of parathyroid disease and hypercalcemia, is essential to the Otolaryngology Head and Neck surgeon (who must treat parathyroid disease), because of the more frequent identification of parathyroid adenomata and parathyroid hyperplasia (with their inherent hypercalcemia). Today many more cases are recognized because of hypercalcemia identified by now routine multiphasic biochemical screening tests. The etiology of hypercalcemia is discussed in considering the differential diagnosis of pseudohyperparathyroidism, and true hyperparathyroidism of parathyroid hyperplasia and parathyroid adenomata. Pseudohyperparathyroidism, secondary to ectopic elaboration of parathormone-like substance is treated medically. Parathyroid hyperplasia can sometimes be controlled medically, but the only definitive treatment for hyperplasia and parathyroid adenomata is surgery, to the extent indicated, in these often critically ill patients with this multisystem disease. Medical, as well as surgical treatment, is described. A patient is described who demonstrated in a slowly moving montage all the classic history and findings of severe hyperparathyroidism in successive phases to her ultimate demise, manifesting neurological, renometabolic , skeletal, cardiovascular and gastrointestinal multisystem symptoms which are described. The complete relief of the acute symptoms following excision of a massive parathyroid adenomata is described and the spectacular pathologic specimen is demonstrated. This patient's course is compared with that of a typical case of pseudohyperparathyroidism.