[Emergency operation for treatment of hyper calcemic crisis due to primary hyperparathyroidism]

Since 1981 to 1993, 7 cases of primary para-hyperthyroidism with hypercalcemic crisis were encountered in PUMC Hospital. One earliest case went to emergency clinic for treatment but patient died within 24 hours in the clinic with no definite diagnosis. Autopsy proved to be single large parathyroid adenoma. 6 cases had blood Calcium level over 15 mg%, equivalent Ca++ level over 1.87 mmol/L. One case died because of unproved diagnosis. The rest 5 cases had parathyroid hormone (PTH) determined or positive findings by imaging diagnosis. Emergency operation has been performed with success, although 1 case need reoperation due to multiple endocrine neoplasm I (MEN-I). The authors emphasis that the application of large quantity infusion, diuretics and calcitonin are necessary pre-operation to reducing operation risk and smoothing postoperation recovery. Pathological diagnosis proved 4 cases were adenoma, one case corresponds to MEN-I. The authors concluded that the emergency operation is safe and effective after proper preoperative preparation, but must be done promptly without delay.