[The parathyrotoxic crisis - a surgical emergency].
BACKGROUND
The extremely rare but life-threatening hypercalcemic crisis is caused by an exacerbation of a chronic hyperparathyroidism. The etiologic reasons for this exacerbation are conditions which increase the serum calcium level in addition to the hyperparathyroidism with a complete breakdown of the calcium homeostasis, e. g. malignant tumors, primary and tertiary hyperparathyroidism, vitamin D poisoning or overdoses of calcium, vitamin D and calcium-containing ionizer in patients with renal insufficiency.


METHODS
We present the clinical course of five patients with an acute hypercalcemic crisis and discuss the diagnostic procedure and the principles of surgical treatment with regard to the current literature.


RESULTS
A hypercalcemic crisis develops if the total serum calcium concentration is over 4 mmol/l and parathormone over 90 pmol/l. The resulting syndrome is manifested by nausea and vomiting, polyuria and consecutive dehydration and hypotonia culminating in lethargy, hallucinations and coma. Hypercalcemia is the single most important diagnostic finding.


CONCLUSIONS
The emergency therapy predominantly consists on the one hand in rehydration and parallel stimulation of diuresis. Urgent surgery is required if conservative therapy is not successful.
Lauschke
H
H
Klinik und Poliklinik für Allgemein-, Visceral-, Thorax- und Gefässchirurgie (Direktor: Prof. Dr. A. Hirner), Rheinische Friedrich-Wilhelms-Universität Bonn.
Kaminski
M
M
Stratmann
H
H
Hirner
A
A
D000208:Acute Disease; D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D004231:Diuresis; D004630:Emergencies; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000150:complications* / Q000628:therapy; D006961:Hyperparathyroidism / Q000097:blood / Q000150:complications* / Q000628:therapy; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D014463:Ultrasonography
D010281:Parathyroid Hormone; D002118:Calcium