The parathyrotoxic crisis - a surgical emergency

Introduction: The extremely rare but life-threatening hypercalcemic crisis is caused by an exacerbation of a chronic hyperparathyroidism. The etiologi c reasons for this exacerbation are conditions which increase the serum cal cium level in addition to the hyperparathyroidism with a complete breakdown of the calcium homeostasis, e.g, malignant turners, primary and tertiary h yperparathyroidism, vitamin D poisoning or overdoses of calcium, vitamin D and calcium-containing ionizer in patients with renal insufficiency. Method s: We present the clinical course of five patients with an acute hypercalce mic crisis and discuss the diagnostic procedure and the principles of surgi cal treatment with regard to the current literature. Results: A hypercalcem ic crisis develops if the total serum calcium concentration is over 4 mmol/ l and parathormone over 90 pmol/l. The resulting syndrome is manifested by nausea and vomiting, polyuria and consecutive dehydration and hypotonia cul minating in lethargy, hallucinations and coma. Hypercalcemia is the single most important diagnostic finding. Conclusion: The emergency therapy predom inantly consists on the one hand in rehydration and parallel stimulation of diuresis. Urgent surgery is required if conservative therapy is not succes sful.