International Journal of Clinical Case Reports 2017, Vol.7, No.9, 38-41
38
Research Report Open Access
Severe Hypercalcemia Secondary to Primary Hyperparathyroidism
Said Azzoug
1
, Houda Boulaam
2
, Djamila Meskine
1
, Farida Chentli
2
1 Endocrine diseases department Bologhine Hospital, Algiers, Algeria
2 Endocrine diseases department Bab El Oued Hospital, Algiers, Algeria
Corresponding author email
International Journal of Clinical Case Reports 2017, Vol.7, No.9 doi
Received: 15 Jul., 2017
Accepted: 31 Jul., 2017
Published: 12 Aug., 2017
Copyright © 2017
Azzoug et al., This is an open access article published under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Preferred citation for this article:
Azzoug S., Boulaam H., Meskine D., and Chentli F., 2017, Severe hypercalcemia secondary to primary hyperparathyroidism, International Journal of
Clinical Case Reports, 7(9): 38-41 (doi
Abstract
Primary hyperparathyroidism is usually asymptomatic or paucisymptomatic, however, in rare cases threatening
hypercalcemia is the presenting symptom. The aim of our study is to analyze cases of severe hypercalcemia in primary
hyperparathyroidism. Subjects and Methods: 5 patients (3M/2F, mean age = 48 years) with primary hyperparathyroidism (2
carcinomas, 3 adenomas) with serum calcium level ≥ 14 mg/dl. Results: Serum calcium levels varied between 14 and 18 mg/dl and
parathormone (PTH) levels between 840 and 1631 pg/ml. Non-specific symptoms such as anorexia, nausea, vomiting, polyuria,
dehydration, abdominal pain, weight loss, fatigue, muscular weakness, pruritus, irritability and lethargy were present in all patients.
Bone fracture and brown tumors were present in 4 patients. Parathyroid nodule size varied between 20 and 46 mm and was clinically
palpable in three patients. All patients received symptomatic treatment of hypercalcemia before parathyroid surgery: rehydration with
saline in all cases, hemodialysis in one case and bisphosphonates in three patients. In the postoperative period, all patients had
hypocalcaemia, which was severe, requiring high amounts of calcium in two patients. Conclusion: Severe hypercalcemia is a rare but
potentially fatal endocrine emergency if unrecognized and untreated. Appropriate diagnosis and adequate management are important
to improve its prognosis.
Keywords
Primary hyperparathyroidism; Severe hypercalcemia; Endocrine emergency
Background
Calcium is the main component of the skeleton; it has major roles on muscle contraction, blood clotting, neuronal
transmission and intracellular signaling. Hypercalcemia is a frequent occurrence in everyday medical practice.
Although most patients will have mild or moderate hypercalcemia, in some cases hypercalcemia may be severe
and life threatening without rapid and efficient treatment.
1 Subjects and Methods
Our study included patients presenting primary hyperparathyroidism with serum calcium levels > 3.5 mmol/l (14
mg/dl).
We reported clinical features, biological results, radiological findings and complications in these patients.
We also reported the symptomatic treatment of hypercalcemia and its effect as well as the etiological treatment of
primary hyperparathyroidism and the evolution in the postoperative period.
2 Results
Five patients presenting primary hyperparathyroidism with severe hypercalcemia were reported. There are 3 males
and 2 females with a mean age of 48 years. Serum calcium levels varied between 3.5 and 4.5 mmol/l (N: 2.1-2.75).
Phosphatemia varied between 0.66 and 0.83 mmol/l (N: 0.83-1.50). Parathormone (PTH) levels varied between
840 and 1631 pg/ml (N: 15-65).
Non-specific symptoms such as anorexia, nausea, vomiting, polyuria, dehydration, abdominal pain, weight loss,
fatigue, muscular weakness, pruritus, irritability and lethargy were present in all patients. Bone lesions: fractures
or brown tumors were seen in four patients. One patient has oligoanuria and another patient has bilateral
