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Abstract: SA-PO516

Hypercalcemic Crisis as a Presentation of Parathyroid Adenoma: An Atypical Clinical Case Study

Session Information

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

  • 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical

Authors

  • Rosario Aulet, Alexandra, Sistema de Salud Episcopal San Lucas, Ponce, Ponce, Puerto Rico
  • Hidalgo- Hernandez, Yolanda I., Sistema de Salud Episcopal San Lucas, Ponce, Ponce, Puerto Rico
Introduction

Hypercalcemia is a common electrolyte disturbance seen in both outpatient and as in patient setting. Normal calcium levels range between 8.6 -10.3mg/dL. Mechanism of hypercalcemia vary in association to the cause, from increase gastrointestinal absorption and bone resorption associated to hypervitaminosis D, to increased bone resorption with tubular reabsorption associated to hyperparathyroidism. Primary hyperparathyroidism and malignancy are the most common causes of hypercalcemia. Primary hyperparathyroidism levels usually elevated but less then 11mg/dL in more rare but severe cases >12mg/dL, levels >13mg/dL usually seen with malignancy and less commonly seen in primary hyperparathyroidism.

Case Description

Case of a 69 y/o female patient with a PMHx of alcohol use disorder, peptic ulcer disease, active smoker being work up as outpatient due to a thyroid nodule which presents to the ED due to disorientation, epigastric pain, constipation associated to 30lbs of unintentional weight loss that has been progressing over the last month. During evaluation patient found oriented x2, GCS 14/15, with unstable gait and benign abdominal examination. Laboratory work up noted for a severe hypercalcemia of 18.4md/dL. Symptoms where refractory to medical treatment with IVF and bisphosphonates requiring renal replacement therapy. Work up done reported primary hyperparathyroidism, which FNA biopsy confirmed parathyroid adenoma. ENT was consulted and left parathyroidectomy and left lobe hemithyroidectomy was performed.

Discussion

Parathyroid crisis is a rare presentation to a parathyroid adenoma. Seen in 1-2% patient with known primary hyperparathyroidism. Parathyroid crisis presents with severe hypercalcemia associated central nervous system dysfunction like changes in mental status, bone disease, nephrolithiasis, or severe abdominal pain. We want to bring awareness to the medical community about diagnosis and treatment since this could be a rare but fatal endocrinology emergency.