Hyperparathyroid crisis (parathyroid storm, parathyroid intoxication) is a rare syndrome of severe hypercalcemia in a patient with primary hyperparathyroidism.
Patients may have parathyroid adenomas or parathyroid carcinomas.
The clinical syndrome may be precipitated by illness, drugs, childbirth or trauma.
Clinical features:
(1) primary hyperparathyroidism with elevated parathyroid hormone (PTH).
(2) profound elevation of serum calcium (> 14 mg/dL)
(3) clinical signs and symptoms of hypercalcemia:
(3a) mental status changes
(3b) nausea and vomiting
(3c) cardiac arrhythmias
(3d) renal dysfunction
(3e) acute pancreatitis
(3f) bone pain
(4) reversal of findings after correction of the hypercalcemia
Therapeutic recommendations of Phitayakorn and McHenry:
(1) rehydration
(2) calciuresis (isotonic sodium chloride and furosemide)
(3) bisphosphonate therapy
(4) parathyroidectomy as definitive procedure
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