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Hyperparathyroid crisis: Characteristics and outcomes

Published:October 18, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.10.028

      Highlights

      • Hyperparathyroid crisis is rare, occurring in 2.4% of hyperparathyroidism patients.
      • Manifested by more severe primary hyperparathyroidism with larger glands.
      • Parathyroid glands more often ectopic and malignant.
      • Higher rate of recurrence and mortality than hyperparathyroidism without crisis.

      Abstract

      Background

      Hyperparathyroid crisis (HPTC) is a potentially lethal condition characterized by severe symptomatic hypercalcemia with calcium levels ≥14 mg/dl. We sought to determine the rate of HPTC and how it differs from hyperparathyroidism (HPT) without crisis (HPTWC).

      Methods

      A retrospective review of patients with surgically treated HPT from 1990 to 2022 was completed.

      Results

      HPTC occurred in 18 (2.4%) of 783 with primary HPT. Patients with HPTC had higher preoperative calcium and parathyroid hormone levels, lower postoperative calcium levels, larger gland weights and higher rates of ectopic glands, carcinoma, recurrence and mortality compared to patients with HPTWC (all p < 0.05).

      Conclusions

      HPTC is a rare condition manifested by severe HPT that is associated with a higher rate of recurrence and mortality compared to HPTWC. HPTC is associated with larger parathyroid glands that are more often ectopic and malignant.

      Graphical abstract

      Keywords

      Abbreviations:

      HPTC (Hyperparathyroid crisis), HPT (Hyperparathyoidism), HPTWC (Hyperparathyroidism without crisis)
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