Mlawa Gideon, Khan Zahid, Azhar Sabeen, Hussein Furhana, Mahamud Bashir, Nugod Abdulrahman
Internal Medicine and Diabetes and Endocrinology, Barking, Havering and Redbridge University Hospitals National Health Services (NHS) Trust, London, GBR.
Acute Medicine, Mid and South Essex National Health Services (NHS) Foundation Trust, Southend on Sea, GBR.
Cureus. 2023 Apr 16;15(4):e37635. doi: 10.7759/cureus.37635. eCollection 2023 Apr.
Hypercalcemia is a common electrolyte abnormality with different causes. Hypercalcemia is most often associated with malignancy and primary hyperparathyroidism and malignancy together account for most cases. Primary hyperparathyroidism manifests as hypercalcemia owing to the overproduction of parathyroid hormone. In most cases, primary hyperparathyroidism manifests due to a solitary parathyroid adenoma. Based on calcium levels, hypercalcemia can be classified as mild, moderate, and severe. Hypercalcemia typically presents with non-specific clinical features. Here, we present the case of a 38-year-old male patient who presented to the emergency department (ED) with acute abdominal pain and a tender abdomen with absent bowel sounds. He had chest radiography and blood tests initially. Chest radiography showed left-sided pneumoperitoneum, and the patient was suspected to have a perforated peptic ulcer due to hypercalcemia secondary to a parathyroid adenoma during the second wave of the coronavirus disease 2019 (COVID-19) pandemic. The findings were confirmed by a computerized tomography scan of the abdomen, and the patient was treated with intravenous fluids for hypercalcemia and was managed conservatively for a sealed perforated peptic ulcer following discussion in the multi-disciplinary team meeting (MDT). The COVID-19 pandemic led to a long waiting list and delays in the timely management of patients requiring elective surgical intervention, such as parathyroidectomy. The patient made a complete recovery and had parathyroidectomy of the inferior right lobe two months later.
高钙血症是一种常见的电解质异常，病因多样。高钙血症最常与恶性肿瘤和原发性甲状旁腺功能亢进相关，这两者共同构成了大多数病例。原发性甲状旁腺功能亢进由于甲状旁腺激素分泌过多而表现为高钙血症。在大多数情况下，原发性甲状旁腺功能亢进是由单个甲状旁腺腺瘤引起的。根据血钙水平，高钙血症可分为轻度、中度和重度。高钙血症通常表现为非特异性临床特征。在此，我们报告一例38岁男性患者，他因急性腹痛和腹部压痛、肠鸣音消失而就诊于急诊科。他最初进行了胸部X线检查和血液检查。胸部X线检查显示左侧气腹，在2019冠状病毒病（COVID-19）大流行的第二波期间，该患者被怀疑因甲状旁腺腺瘤继发高钙血症导致消化性溃疡穿孔。腹部计算机断层扫描证实了这些发现，该患者接受了静脉补液治疗高钙血症，并在多学科团队会议（MDT）讨论后对闭合性消化性溃疡穿孔进行了保守治疗。COVID-19大流行导致了很长的等待名单，并延误了对需要择期手术干预（如甲状旁腺切除术）患者的及时治疗。该患者完全康复，两个月后接受了右下叶甲状旁腺切除术。
