Clinical Diagnosis and Management of Hypercalcemic crisis resulting from Hyperparathyroidism：A 16-Year Experience with 79 Cases
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Background To analyze a large-sample cohort of hypercalcemic crisis cases caused by hyperparathyroidism, focusing on etiology, clinical manifestations, diagnosis, emergency treatments, and etiological treatments. Methods Patients with hypercalcemic crisis due to hyperparathyroidism admitted in our institution from January 2009 to January 2025 were enrolled. Comprehensive data included demographic characteristics, clinical manifestations, etiological subtypes, imaging examination, emergency treatments, and etiological treatments. Serial assessments of serum parathyroid hormone, calcium, and phosphorus levels were compared pre- and post-emergency treatment. Results A total of 79 patients (39 males, 40 females) were included, with a mean age of (51.51 ± 15.74) years. Primary hyperparathyroidism accounted for 93.67% (74/79), while tertiary hyperparathyroidism accounted for 6.33% (5/79). Clinical manifestations included endocrine symptoms (83.54%, 66/79), gastrointestinal symptoms (74.68%, 59/79), skeletal symptoms (68.35%, 54/79), renal symptoms (59.49%, 47/79), neurological symptoms (56.96%, 45/79), and cardiovascular symptoms (20.25%, 16/79). After the administration of emergency calcium-lowering therapy (hydration, subcutaneous calcitonin, intravenous bisphosphonates, or hemodialysis), 88.61% (70/79) patients got clinical improvement. Surgical parathyroidectomy achieved a 100% improvement rate (36/36 primary hyperparathyroidism; 2/2 tertiary hyperparathyroidism). All three patients (2 primary hyperparathyroidism, 1 tertiary hyperparathyroidism) treated with microwave ablation achieved complete remission. Conclusions Hypercalcemic crisis caused by hyperparathyroidism presents with diverse and nonspecific clinical manifestations. It has challenges for early diagnosis and increasing risks of misdiagnosis. Efficient and thorough calcium-reducing interventions in the emergency context can facilitate a fast alleviation of clinical manifestations. Total parathyroidectomy and microwave ablation can get high cure rates and lead to sustained clinical remission.
