Department of Surgery, Yale University School of Medicine, P.O. Box 208062, New Haven, CT 06520-8062, USA.
World J Surg. 2011 Feb;35(2):331-5. doi: 10.1007/s00268-010-0840-6.
The clinical and pathological characteristics of hyperparathyroidism-induced hypercalcemic crisis (HIHC) are incompletely described. The present study was designed to elucidate the nature and effects of HIHC in patients undergoing parathyroidectomy in our unit.
A prospective database of 1,754 consecutive patients with primary hyperparathyroidism (PHPT) who underwent parathyroidectomy from 1991-2009 identified 67 (41 women) patients presenting with HIHC. Hyperparathyroidism-induced hypercalcemic crisis was defined as symptoms and signs of acute calcium intoxication with a concomitant total albumin corrected calcium level>13.5 mg/dl (range: 8.8-10.2 mg/dl). Clinical and pathological characteristics were evaluated. Data are expressed as mean±SEM.
Mean age at presentation was 56.7±2.2 years. Twenty-four of 67 patients (35%) required preoperative in-hospital management. Of these, all were treated with saline resuscitation, whereas 20/24 (83%) were treated pharmacologically. Neurocognitive derangements and nephrolithiasis with associated hematuria were the most common presenting symptoms and signs. Preoperative serum calcium and the intact parathyroid hormone level (PTH) were 14.0±0.19 mg/dl and 393±43 pg/ml (reference range: 12-65 pg/ml), respectively. Minimally invasive parathyroidectomy under local cervical block was performed in 28/67 patients (42%); the remainder underwent standard cervical exploration. All patients had postoperative normalization of serum calcium and intact PTH. Hyperparathyroidism-induced hypercalcemic crisis was due to parathyroid carcinoma in 3/67 patients (4.5%), whereas the remainder of patients displayed a single parathyroid adenoma (n=57) or multiglandular hyperplasia (n=7). Histopathological evaluation from HIHC patients revealed a chief cell microcystic pattern in 15/21 (71.4%) of examined parathyroid tumors.
Hyperparathyroidism-induced hypercalcemic crisis is most commonly due to a single parathyroid adenoma, often associated with a microcystic histopathological pattern. The condition is optimally managed with saline hydration and urgent parathyroidectomy.
甲状旁腺功能亢进性高钙血症危象（HIHC）的临床和病理特征尚未完全描述。本研究旨在阐明我们单位甲状旁腺切除术患者中 HIHC 的性质和影响。
从 1991 年至 2009 年，对 1754 例原发性甲状旁腺功能亢进症（PHPT）连续患者的前瞻性数据库进行分析，确定了 67 例（41 例女性）出现 HIHC 的患者。甲状旁腺功能亢进性高钙血症危象定义为伴有总白蛋白校正钙水平>13.5mg/dl（范围：8.8-10.2mg/dl）的急性钙中毒症状和体征。评估临床和病理特征。数据表示为平均值±SEM。
就诊时的平均年龄为 56.7±2.2 岁。67 例患者中有 24 例（35%）需要术前住院治疗。其中，所有患者均接受生理盐水复苏治疗，而 24/24 例（83%）接受了药物治疗。神经认知障碍和肾结石伴血尿是最常见的症状和体征。术前血清钙和完整甲状旁腺激素水平（PTH）分别为 14.0±0.19mg/dl 和 393±43pg/ml（参考范围：12-65pg/ml）。28/67 例患者（42%）行局部颈块微创甲状旁腺切除术；其余患者行标准颈探查术。所有患者术后血清钙和完整 PTH 均恢复正常。HIHC 患者中甲状旁腺癌导致 HIHC 的 3/67 例（4.5%），其余患者为单个甲状旁腺腺瘤（n=57）或多腺体增生（n=7）。对 HIHC 患者的甲状旁腺肿瘤进行组织病理学评估，发现 21 例（71.4%）检查的甲状旁腺肿瘤中存在主细胞微囊模式。
甲状旁腺功能亢进性高钙血症危象最常见于单个甲状旁腺腺瘤，常伴有微囊组织病理学模式。盐水水化和紧急甲状旁腺切除术是最佳治疗方法。
