Hyperparathyroid Crisis due to Primary Hyperparathyroidism

Abstract

A 69-year-old male with chest pain was admitted to a private clinic, and treatment of cardiac infarction was started. General fatigue and disturbed of consciousness developed. Blood examination revealed a high serum calcium level. With conservative treatment his general condition improved. A sonogram revealed a tumor behind the thyroid gland. He continued to be treated conservatively, but his serum calcium did not decrease, and he became confused and drowsy. Serum levels of amylase, BUN and creatinine were also markedly elevated. He was referred to our clinic for a surgery. A hard tumor, 40 mm × 30 mm, was palpated at the posteroinferior edge of the thyroid gland. A CT scan and a sonogram revealed a tumor posterior to the right lobe of the thyroid gland. Soon after admission, he went into a deep coma and then respiratory arrest. Endotracheal inturbation and respiratory support were required. Tumor extirpation was done under general anesthesia. The tumor was not adherent to the surrounding tissue. It was light yellowish, elastic hard, 44 mm × 27 mm × 15 mm in size and 8 g in weight. Histopathological examination established the diagnosis of parathyroid adenoma. The serum calcium level fell to the normal range 2 days after operation and the BUN and creatinine 18 days after operation. Disturbance of consciousness improved dramatically after the serum calcium became normal. Hyperparathyroid crisis has a high motality, and the only treatment is surgical removal. Therefore, in patients with primary hyperparathyroidism, surgical removal should be done as soon as possible. © 1989, The Society of Practical Otolaryngology. All rights reserved.