Severe hypercalcaemia of primary hyperparathyroidism: Could giant adenoma be the real culprit rather than carcinoma?

Hypercalcaemic crisis is a rare manifestation of hyperparathyroidism and occurs in 1.6-6% of patients with primary hyperparathyroidism (pHPT). Although such high serum calcium levels (>14mg/dl) are attributed to malignancy, it is also associated with benign disease of the parathyroid glands. The...

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Bibliographic Details
Published in:Annals of the Royal College of Surgeons of England 2020-05, Vol.102 (5), p.363-368
Main Authors: Gücek Haciyanli, S, Acar, N, Gür, E Ö, Çelik, S C, Karaıslı, S, Dilek, O N, Haciyanli, M
Format: Article
Language:English
Subjects:
Adenoma - blood
Adenoma - complications
Adenoma - surgery
Adult
Age
Aged
Asymptomatic
Bisphosphonates
Calcification
Calcium - blood
Carcinoma - blood
Carcinoma - complications
Carcinoma - surgery
Cardiac arrhythmia
Diphosphonates - administration & dosage
Endocrine Surgery
Female
Furosemide - administration & dosage
Hemodialysis
Histopathology
Humans
Hydration
Hypercalcemia - blood
Hypercalcemia - diagnosis
Hypercalcemia - etiology
Hypercalcemia - therapy
Hyperparathyroidism, Primary - blood
Hyperparathyroidism, Primary - etiology
Hyperparathyroidism, Primary - surgery
Hypertension
Localization
Male
Middle Aged
Pain
Parathyroid Glands - pathology
Parathyroid Glands - surgery
Parathyroid Neoplasms - blood
Parathyroid Neoplasms - complications
Parathyroidectomy
Patients
Postoperative Period
Renal Dialysis
Retrospective Studies
Scintigraphy
Severity of Illness Index
Standard deviation
Surgery
Treatment Outcome
Tumors
Ultrasonic imaging
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Summary:Hypercalcaemic crisis is a rare manifestation of hyperparathyroidism and occurs in 1.6-6% of patients with primary hyperparathyroidism (pHPT). Although such high serum calcium levels (>14mg/dl) are attributed to malignancy, it is also associated with benign disease of the parathyroid glands. The aim of this study was to evaluate the clinical features and treatment modalities of patients with severe hypercalcaemia who underwent surgery for pHPT. The medical records of 537 patients who underwent parathyroidectomy in our department for pHPT between 2005 and 2019 were reviewed retrospectively. Twenty-four (4.4%) of the patients were described as having severe hypercalcaemia. Among 24 patients, 71% were female and the mean age was 55.7 years (range: 40-71 years). The mean serum calcium level at time of diagnosis was 15.9mg/dl (range: 14-22.7mg/dl). According to postoperative pathology reports, solitary adenoma, parathyroid cancer and parathyromatosis were diagnosed with the rates of 87.5%, 8.3% and 4.1% respectively. The mean weight of the solitary parathyroid lesions was 14.9g (standard deviation: 8.9g, range: 4-38g). The mean longest diameter was 2.87cm (standard deviation: 1.4cm, range: 1-5.5cm). Serum calcium levels were within the normal range on the first postoperative day in 75% of the cases. Severe hypercalcaemia is a rare but urgent condition of pHPT and requires prompt management. Accelerated surgery after adequate medical treatment should be performed. It is important to emphasise that giant adenoma, which is a benign disease, may be a more common cause of severe hypercalcaemia than carcinoma, unlike previously thought.
ISSN:0035-8843
1478-7083
DOI:10.1308/RCSANN.2020.0039