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[Calcium induced necroses of cardiac muscle causing death in acute hyperparathyroidism (author's transl)]
Insights
A rare case of fatal acute primary hyperparathyroidism caused myocardial necrosis due to severe hypercalcemia. This condition, marked by high calcium and phosphate levels, led to cardiac failure and death.
Area of Science:
- Endocrinology
- Cardiology
- Pathology
Background:
- Acute myocardial infarction symptoms prompted hospital admission for a 66-year-old female.
- Initial assessment revealed elevated creatine kinase (CK) and CK-MB levels, consistent with myocardial infarction.
- Electrocardiogram (ECG) showed a complete left bundle branch block, indicating significant cardiac compromise.
Observation:
- Massive hypercalcemia (6.2 mmol/l) and hyperphosphatemia (1.6 mmol/l) were noted, suggesting acute primary hyperparathyroidism.
- Elevated parathormone levels (>100,000 ng/l) confirmed the diagnosis.
- Necropsy revealed chief cell adenoma, skeletal and renal changes of hyperparathyroidism, and disseminated cardiac calcifications and necroses.
Findings:
- The patient died within hours from cardiac failure.
- Disseminated calcifications and fresh myocardial necroses were observed in the heart.
- Coronary arteries were found to be normal, ruling out typical ischemic heart disease.
Implications:
- This case represents the first clinical report of fatal acute primary hyperparathyroidism.
- Hypercalcemia-induced myocardial necrosis is a critical, potentially lethal complication of acute primary hyperparathyroidism.
- Highlights the importance of considering endocrine emergencies in unexplained cardiac events.
Abstract:
Typical symptoms of acute myocardial infarction led to admission of a 66-year-old female. Creatine kinase (CK) was 720 U/l on admission and together with CK-MB of 108 U/l fitted the clinical picture. The ECG showed complete left bundle branch block. The patient died a few hours later in cardiac failure. Massive hypercalcaemia of 6.2 mmol/l and hyperphosphataemia of 1.6 mmol/l suggested acute primary hyperparathyroidism already clinically which later could be verified by a parathormone level of more than 100 000 ng/l ("C-terminal assay"). At necropsy chief cell adenoma of the epithelial bodies was found, typical changes of primary hyperparathyroidism in the skeleton and kidneys, and disseminated calcifications and fresh necroses of cardiac muscle. The coronaries were normal. This is the first clinical report of fatal acute primary hyperparathyroidism due to hypercalcaemia-induced myocardial necroses.