Fatal Hypercalcemic Crisis Secondary to Primary Hyperparathyroidism: A Case Report
https://doi.org/10.15605/jafes.041.S1
- Author:
Pey Hui See
1
;
Ee Wen Loh
1
;
Pei Lin Chan
1
;
Florence Hui Sieng Tan
1
Author Information
1. Endocrinology Unit, Department of Medicine, Sarawak General Hospital
- Publication Type:Journal Article
- MeSH:
Hyperparathyroidism, Primary
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):75-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Hypercalcemic crisis, a decompensated state characterized
by multiorgan dysfunction and a corrected serum calcium
(CCa) level typically >3.5 mmol/L, is a rare but lifethreatening endocrine emergency that requires prompt
recognition and aggressive multimodal management. We
report a fatal case of hypercalcemic crisis secondary to
primary hyperparathyroidism, which was refractory to
multiple lines of medical therapy.
Case:A 55-year-old female with diabetes mellitus, hypertension,
and chronic kidney disease (creatinine 159 umol/L; estimated glomerular filtration rate 33 mL/min) presented with
3 days of confusion, profound fatigue, and constipation,
preceded by a 1-month history of polyuria and polydipsia.
Her Glasgow Coma Scale (GCS) was E4V3M5. Physical
examination was unremarkable, with no palpable neck
swelling. Significant laboratory findings included severe
hypercalcemia with markedly elevated serum intact
parathyroid hormone (iPTH) (CCa 4.49 mmol/L; phosphate
1.01 mmol/L; iPTH 60.1 pmol/L [N 1.6–6.0]; creatinine
149 umol/L). Saline diuresis was initiated together with
subcutaneous calcitonin, resulting in an initial biochemical
response, with CCa decreasing to a nadir of 3.61 mmol/L.
However, the CCa subsequently rebounded to 5.00 mmol/L.
Hemodialysis was performed, followed by administration
of subcutaneous denosumab 60 mg. Nonetheless, the CCa
decreased only modestly to 4.28 mmol/L. She became
increasingly drowsy, and her clinical course was further complicated by aspiration pneumonia and lung collapse,
leading to respiratory failure requiring intubation and
inotropic support. Despite intensive care, additional
sessions of hemodialysis and continuous renal replacement
therapy, her CCa remained persistently above 4.0 mmol/L,
peaking at 5.35 mmol/L. Due to her critical condition,
imaging for lesion localization could not be performed.
She eventually succumbed to her illness on day 10 of
admission, before definitive surgery could be undertaken.
Conclusion:This case highlights the potentially fatal course of
hypercalcemic crisis secondary to primary hyperparathyroidism. The reported mortality rate is high, at around
60%. Early recognition and intensive management,
including emergency parathyroidectomy in resistant cases,
have been shown to be crucial in improving outcomes.
- Full text:2026080410595773815EP_A101.pdf
