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. 2024 Apr 15;63(8):1139-1147.
doi: 10.2169/internalmedicine.1764-23. Epub 2023 Sep 8.

Hypercalcemic Crisis Due to Parathyroid Adenoma Improved by Continuous Hemodialysis with a Common Calcium Concentration Dialysate: Discussion of Therapeutic Management

Hirohito Okuyama  1 , Ryuta Sato  1 , Katsuhiko Enomoto  2 , Juko Asakura  1 , Takashi Hatakeyama  1
Affiliations

Hypercalcemic Crisis Due to Parathyroid Adenoma Improved by Continuous Hemodialysis with a Common Calcium Concentration Dialysate: Discussion of Therapeutic Management

Hirohito Okuyama et al. Intern Med. .

Abstract

A hypercalcemic crisis due to primary hyperparathyroidism is a life-threatening condition. We herein report a 71-years-old man with hypercalcemic crisis due to primary hyperparathyroidism with parathyroid adenoma. Generally, hemodialysis or continuous hemodiafiltration using calcium-free or low-calcium dialysate is performed early for hypercalcemic crisis. In this case, continuous hemodialysis with a common calcium concentration dialysate improved the hypercalcemic crisis, and parathyroidectomy was performed. The patient recovered sufficiently. Prediction of hypercalcemia crisis, appropriate introduction and methods of blood purification therapy, and timing decisions for parathyroidectomy are required for therapeutic management of hypercalcemic crisis with parathyroid adenoma.

Keywords: calcium concentration; continuous hemodialysis; dialysate; hypercalcemic crisis; parathyroidectomy.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
The clinical course of serum corrected calcium level, intact PTH level, creatinine level, body weight, urine out-put and medical treatments. CHD: continuous hemodialysis, HD: hemodialysis, ZA: Zoledronate, F: furosemide, PTH: parathyroid hormone, Cre: creatinine, int-PTH: intact PTH, POD: postoperative day
Figure 2.
Figure 2.
CT scan and Tc-mibi scintigraphy. CT demonstrates a 22×17×50 mm hypodense lesion on the right lobe of the thyroid gland (white arrow). 99mTc-MIBI scintigraphy shows the accumulation within the tumor lesion without any other significant accumulation (black arrow). CT: computed tomography, 99mTc-MIBI: 99mTc-methoxyisobutylisonitrile
Figure 3.
Figure 3.
Resection specimen and pathology. (a) Macroscopic finding of the resected right parathyroid adenoma. The parathyroid is extremely enlarged. (b) Histologically, tumor cells with small round nuclei and perinuclear halos proliferated diffusely in the parathyroid gland. (c) Immunohistochemistry of PTH revealed that approximately all tumor cells were positive for PTH. PTH: parathyroid hormone
See this image and copyright information in PMC

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