title: Heart block and acute kidney injury due to hyperparathyroidism-induced hypercalcemic crisis.
abstract: We describe a patient who presented with multi-system organ failure due to extreme hypercalcemia (serum calcium 19.8 mg/dL), resulting from primary hyperparathyroidism. He was found to have a 4.8 cm solitary atypical parathyroid adenoma. His course was complicated by complete heart block, acute kidney injury, and significant neurocognitive disturbances. Relevant literature was reviewed and discussed. Hyperparathyroidism-induced hypercalcemic crisis (HIHC) is a rare presentation of primary hyperparathyroidism and only a small minority of these patients develop significant cardiac and renal complications. In cases of HIHC, a multidisciplinary effort can facilitate rapid treatment of life-threatening hypercalcemia and definitive treatment by surgical resection. As such, temporary transvenous cardiac pacing and renal replacement therapy can provide a life-saving bridge to definitive parathyroidectomy in cases of HIHC.
authors.affiliation: Department of Surgery, Section of Endocrine Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Taylor C
authors.initials: TC
authors.lastname: Brown
authors.affiliation: Department of Surgery, Section of Endocrine Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: James M
authors.initials: JM
authors.lastname: Healy
authors.affiliation: Department of Pathology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: McDonald
authors.affiliation: Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Joni H
authors.initials: JH
authors.lastname: Hansson
authors.affiliation: Department of Surgery, Section of Endocrine Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Courtney E
authors.initials: CE
authors.lastname: Quinn
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000368:Aged; D006327:Heart Block / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology*; D006961:Hyperparathyroidism / Q000150:complications*; D008297:Male; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D014463:Ultrasonography
keywords: acute kidney injury; heart block; hypercalcemic crisis; hyperparathyroidism