Long-term results of parathyroidectomy for hypercalcemic crisis.
OBJECTIVE
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.


METHODS
Retrospective case series.


METHODS
Tertiary referral center.


METHODS
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.


METHODS
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).


CONCLUSIONS
Hypercalcemic crisis can be successfully treated by parathyroidectomy with continued normal parathyroid function and excellent long-term survival.
Lew
John I
JI
DeWitt Daughtry Family Department of Surgery, University of Miami/Jackson Memorial Veterans Affairs, Miami, FL 33131, USA.
Solorzano
Carmen C
CC
Irvin
George L
GL
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
D002118:Calcium