HYPERCALCEMIC CRISIS

The paper presents the peculiarities of history, clinic, presurgical preparation, surgical intervention, and postoperative period in patients with hypercalcemic crisis caused by primary hyperparathyroidism (PHPT). During 2000-2013, 5 of 214 patients with PHPT who developed hypercalcemic crisis were operated on. In 3 of them, histological analysis verified parathyroid adenoma, in 1 – parathyroid hyperplasia, and in 1 – parathyroid carcinoma. In 4 of 5 patients, PHPT was first revealed against the background of hypercalcemic crisis. In one female patient, PHPT was found “against the background” of 25-26-week pregnancy. Due to abdominal symptoms (abdominal pain, vomiting) characteristic of the hypercalcemic crisis, she underwent abdominal cavity revision in the Central Municipal Hospital. PHPT was diagnosed later, in the MONIKI Department of Abdominal Surgery. In the other female patient who was observed at the place of her residence for arthritis, the level of parathyroid hormone (PTH) before surgery reached 6490 pg/ml, and calcium – 3.75 mol/L. In the postoperative period, she developed not only acute renal but also adrenal failure. In one patient with known PHPT and not very high calcium and PTH levels, hypercalcemic crisis developed against the background of abdominal surgery. This female patient was operated on in two days after the first operation because she was in coma due to developed hypercalcemic crisis. Two more female patients were admitted to the clinic of endocrine surgery in severe condition. In one of them, PHPT was mistaken for rheumatoid arthritis or myeloid disease for several years, in the other, polyuria of unclear genesis was noted. In 4 of these 5 patients, in the nearest postoperative period, marked electrolytic disturbances developed (decreased levels of calcium, potassium, phosphorus, and magnesium) as well as an acute renal failure, polyorganic insufficiency, and syndrome of disseminated intravascular blood coagulation. In the nearest postoperative period, three patients died (on the 22nd, 32nd, and 34^th day). In this connection, in patients with revealed PHPT, the surgical operations for the given disease as well as on the other organs should be performed simultaneously. The levels of creatinine, calcium, phosphorus, magnesium, and blood potassium should be under the control as well as an arterial pressure (every 2-3 hours), and blood coagulation (not less than during 10 days and then every week during 2-3 months at the place of residence).