Surgical treatment of patients with primary hyperparathyroidism with a risk of hypercalcaemic crisis
Abstract
Introduction: The objective of the work was to evaluate the effectiveness of surgical treatment in patients with a high risk of hypercalcaemic crisis due to primary hyperparathyroidism (PHPT) and to determine the best time to undergo surgery.
Material and methods and Results: Between 2010 and 2019, 627 patients underwent surgery due to PHPT. Sixty-two patients (9.9%) (47 women and 15 men, aged 28–79 years, average 53.7 years) faced the threat of a parathyroid crisis. In these patients, the average parathyroid hormone (PTH) levels were 774.02 pg/mL (95% CI: 203–1246 pg/mL) and ionised calcium (iCa2+) 1.91 mmol/L (95% CI: 1.70–2.2 mmol/L). The PTH postoperative concentration averaged at 37.86 pg/mL (95% CI: 9.91–42.7 pg/mL) and iCa2 + 1.11 mmol/L (95% CI: 1.07–1.21 mmol/L). Bilateral neck exploration was performed in all patients with the removal of the affected parathyroid gland and biopsies of other parts. Histopathological examination revealed adenoma in 42 cases (67.7%), hyperplasia in 16 (25.7%), and parathyroid cancer in four of the patients (6.6%). Comparison of tests before and after surgery showed a statistically significant decrease in PTH (p < 0.001) and iCa (p < 0.001) in blood serum.
Conclusions: A developing hypercalcaemic crisis in the course of hyperparathyroidism is an indication for preoperative intensive medical therapy, along with urgent surgical intervention and removal of diseased parathyroid glands. This type of surgery should be performed as soon as possible, even if there are no imaging tests, only based on an assessment of the general condition of the patient and their serum calcium levels.
Keywords: hyperparathyroidismprimarysurgeryhypercalcaemic crisisparathyroidectomy
References
- Agarwal A, Singh D, Gupta S, et al. Primary hyperparathyroidism presenting as hypercalcemic crisis: Twenty-year experience. Indian J Endocrinol Metab. 2015; 19(1): 100.
- Lew J. Long-term Results of Parathyroidectomy for Hypercalcemic Crisis. Arch Surg. 2006; 141(7): 696.
- Wang CA, Guyton S. Hyperparathyroid Crisis. Ann Surg. 1979; 190(6): 782–790.
- Kasperk C. Hyperkalzämische Krise und hypokalzämische Tetanie. Internist (Berl). 2017; 58(10): 1029–1036.
- Gellert R. Hipo- i hiperkalcemia — patogeneza i problemy terapeutyczne. Forum Nefrologiczne. 2011; 4: 373–382.
- Dąbrowska A, Tarach J, Zwolak A. Pierwotna nadczynność przytarczyc w przebiegu raka przytarczyc — wyzwanie diagnostyczne i terapeutyczne. Endokrynol Pol. 2015; 66(2): 150–167.
- Jacob JJ, John M, Thomas N, et al. Does hyperparathyroidism cause pancreatitis? A South Indian experience and a review of published work. ANZ J Surg. 2006; 76(8): 740–744.
- Agarwal A, George RK, Gupta SK, et al. Pancreatitis in patients with primary hyperparathyroidism. Indian J Gastroenterol. 2003; 22(6): 224–225.
- Brown TC, Healy JM, McDonald MJ, et al. Heart block and acute kidney injury due to hyperparathyroidism-induced hypercalcemic crisis. Yale J Biol Med. 2014; 87(4): 563–567.
- Wieliczko M, Staszków M, Matuszkiewicz-Piwońska J. Approach to a patient with the hypercalcemic crisis. Nephrol Dial Pol. 2013; 17: 116–117.
- Lowell A, Bushman N, Wang X, et al. Assessing the risk of hypercalcemic crisis in patients with primary hyperparathyroidism. J Surg Res. 2017; 217: 252–257.
- Shah VN, Bhadada SK, Bhansali A, et al. Influence of age and gender on presentation of symptomatic primary hyperparathyroidism. J Postgrad Med. 2012; 58(2): 107–111.
- Gurrado A, Piccinni G, Lissidini G, et al. Hypercalcaemic crisis due to primary hyperparathyroidism — a systematic literature review and case report. Endokrynol Pol. 2012; 63(6): 494–502.
- Starker L, Björklund P, Theoharis C, et al. Clinical and Histopathological Characteristics of Hyperparathyroidism-induced Hypercalcemic Crisis. World J Surg. 2010; 35(2): 331–335.
- Phitayakorn R, McHenry C. Hyperparathyroid Crisis: Use of Bisphosphonates as a Bridge to Parathyroidectomy. J Am Coll Surg. 2008; 206(6): 1106–1115.
- Ahmad S, Kuraganti G, Steenkamp D. Hypercalcemic Crisis: A Clinical Review. Am J Med. 2015; 128(3): 239–245.
- Beck W, Lew J, Solórzano C. Hypercalcemic Crisis in the Era of Targeted Parathyroidectomy. J Surg Res. 2011; 171(2): 404–408.
- Cannon J, Lew J, Solórzano C. Parathyroidectomy for hypercalcemic crisis: 40 years' experience and long-term outcomes. Surgery. 2010; 148(4): 807–813.
- Rutkowska J, Bandurska-Stankiewicz E, Matuszewski W, et al. Pierwotna nadczynność przytarczyc w ciąży — wyzwanie diagnostyczne i terapeutyczne. Endokrynol Pol. 2015; 66(3): 270–274.
- Gawrychowski J, Buła G. Imaging diagnostics for primary hyperparathyroidism. Endokrynol Pol. 2013; 64(5): 404–408.
- Gawrychowski J, Kowalski G, Buła G. Parathyroid Carcinoma — Diagnosis and Surgical Treatment a 24-year Experience. Pol J Surg. 2010; 82(2): 157.
- Gawrychowski J, Kowalski G, Gawrychowska A. Parathyroid Cancer — Occurrence, Diagnosis, Treatment. Pol J Surg. 2008; 80(9): 928–944.
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