Hyperparathyroid crisis: Characteristics and outcomes

Published:October 18, 2022DOI:


      • 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.



      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).


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


      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).


      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



      HPTC (Hyperparathyroid crisis), HPT (Hyperparathyoidism), HPTWC (Hyperparathyroidism without crisis)
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        • Phitayakorn R.
        • McHenry C.R.
        Hyperparathyroid crisis: the use of bisphosphonates as a bridge to parathyroidectomy: a case series and review of the literature.
        J Am Coll Surg. 2008; 206: 1106-1115
        • Lew J.I.
        • Solorzano C.C.
        • Irvin 3rd, G.L.
        Long-term results of parathyroidectomy for hypercalcemic crisis.
        Arch Surg. 2006; 141 (; discussion 700): 696-699
        • Cannon J.
        • Lew J.I.
        • Solorzano C.C.
        Parathyroidectomy for hypercalcemic crisis: 40 years' experience and long-term outcomes.
        Surgery. 2010; 148 (discussion 812-813): 807-812
        • Starker L.F.
        • Björklund P.
        • Theoharis C.
        • et al.
        Clinical and histopathological characteristics of hyperparathyroidism-induced hypercalcemic crisis.
        World J Surg. 2011; 35: 331-335
        • Beck W.
        • Lew J.I.
        • Solorzano C.C.
        Hypercalcemic crisis in the era of targeted parathyroidectomy.
        J Surg Res. 2011; 171: 404-408
        • Lowell A.J.
        • Bushman N.M.
        • Wang X.
        • et al.
        Assessing the risk of hypercalcemic crisis in patients with primary hyperparathyroidism.
        J Surg Res. 2017; 217: 252-257
        • Wilhelm S.M.
        • Wang T.S.
        • Ruan D.T.
        • et al.
        The American association of endocrine surgeons guidelines for definitive management of primary hyperparathyroidism.
        JAMA Surg. 2016; 151: 959-968
        • Maselly M.J.
        • Lawrence A.M.
        • Brooks M.
        • et al.
        Hyperparathyroid crisis: successful treatment of ten comatose patients.
        Surgery. 1981; 90: 741-746
        • Wang C.A.
        • Guyton S.W.
        Hyperparathyroid crisis: clinical and pathologic studies of 14 patients.
        Ann Surg. 1979; 190: 782-790
        • Singh D.N.
        • Gupta S.K.
        • Kumari N.
        • et al.
        Indian Journal of Endocrinology and Metabolism. 2015; 19: 100-105
        • Gurrado A.
        • Piccinni G.
        • Lissidini G.
        • et al.
        Hypercalcaemic crisis due to primary hyperparathyroidism: a systematic literature review and case report.
        Endokrynol Pol. 2012; 63: 494-502