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John I. Lew, MD; Carmen C. Solorzano, MD; George L. Irvin III, MD

Arch Surg. 2006;141:696-699.

Hypothesis  Hypercalcemic crisis is a rare complication of severe calcium intoxication usually caused by sporadic primary hyperparathyroidism that requires prompt diagnosis and definitive surgical treatment. Parathyroidectomy is essential for long-term successful treatment of hypercalcemic crisis.

Design  Retrospective case series.

Setting  Tertiary referral center.

Patients  Forty-three patients treated for hypercalcemic crisis during a 35-year period who had signs and symptoms of acute calcium intoxication and serum calcium levels of 15 mg/dL (3.75 mmol/L) or greater.

Main Outcome Measures  Operative success, operative failure, and disease recurrence after surgery. Kaplan-Meier analysis was used to estimate long-term survival after parathyroidectomy.

Results  Forty-two (98%) of 43 patients were eucalcemic after initial parathyroidectomy. There was 1 postoperative death. Of 27 patients with postoperative calcium data available for 6 months or longer, operative success was achieved in 26 (96%). There was 1 operative failure in a patient with multiglandular disease requiring reoperation. There were 3 recurrences (7%) at 7, 58, and 265 months. Overall median survival after parathyroidectomy was 11.7 years (95% confidence interval, 9.2-NE [not estimable]). The mean ± SD serum calcium level of this group at a median follow-up of 4 years after surgery was 9.1 ± 0.9 mg/dL (2.28 ± 0.23 mmol/L).

Conclusion  Hypercalcemic crisis can be successfully treated by parathyroidectomy with continued normal parathyroid function and excellent long-term survival.

Author Affiliations: DeWitt Daughtry Family Department of Surgery, University of Miami/Jackson Memorial, Veterans Affairs, and Sylvester Comprehensive Cancer Medical Centers, Miami, Fla.

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