Chapter 26 - Acute Primary Hyperparathyroidism

Abstract

Prior to the development of multichannel autoanalyzers, primary hyperparathyroidism (PHPT) was an infrequent diagnosis and was often associated with clear manifestations of end-organ disease. Older clinical descriptions of PHPT were associated with symptoms related to the effects of parathyroid hormone (PTH) on the kidney and bone. Acute, severe hypercalcemia (parathyroid poisoning, parathyroid intoxication, parathyroid storm, or parathyroid crisis) was described as a possible serious complication of PHPT. PHPT now most commonly presents as asymptomatic hypercalcemia due the frequent screening of serum calcium levels. However, severe life-threatening, symptomatic hypercalcemia is still described, albeit rarely. Invariably, marked signs and symptoms are present. Patients are also usually identified by their altered mental status, nausea, vomiting, pancreatitis, and renal and/or cardiac manifestations that can be associated with hypercalcemia. Although rare, the number of cases in the medical literature and the curable nature of the disorder indicate that this disease must be considered in the differential diagnosis of severe hypercalcemia.