EMERGENCY CONDITIONS IN ENDOCRINE SURGERY: HYPERCALCEMIC CRISIS

Introduction. Hypercalcemic crisis is a severe complication of primary hyperparathyroidism manifested by the development of pronounced disorders of water-electrolyte balance due to rapid increase of hypercalcemia up to 3.5 mmol/l and higher in combination with manifest clinical picture of hyperparathyroidism and phenomena of multiorgan dysfunction. Material and methods. A retrospective study of case histories of 528 patients treated for perithyroid gland diseases in the clinics of the Department of Hospital Surgery of St. Petersburg State Medical University from 1973 to 2022 was performed. Results. The study presents the analysis of treatment of 12 patients with primary hyperparathyroidism complicated by the development of hypercalcemic crisis. The clinical picture imitated various emergency conditions — acute pancreatitis, cerebral circulation disorder, acute coronary syndrome, intoxication in infectious diseases, renal failure, which in the absence of data on hyperparathyroidism in the anamnesis made the stage of diagnosis difficult. The detection of severe hypercalcemia in all 12 patients allowed to suspect parathyroid tumor: the level of total serum calcium varied from 3,78 to 5,6 mmol/l (normal 2.1–2.55 mmol/l), and averaged 4.23±0.18 mmol/l. The stage of topical diagnosis was shortened due to the severity of the patients’ condition and indications for urgent surgical intervention. All the patients required preoperative preparation aimed at reducing calcium level and rehydration, correction of anemia.
The infusion volume was selected individually, crystalloid solutions, potassium and magnesium preparations were used for rehydration under control of serum electrolyte content. Diuretics were
administered to accelerate calcium excretion with urine. Surgical treatment included removal of parathyroid tumor. Under general anesthesia, bilateral neck revision was performed, all parathyroid glands were examined, and parathyroid tumors were removed. Multiple parathyroid tumors (two) were found in one observation. Paratgormone decreased sharply in the postoperative period to 5.05– 15 pg/mL, with an average of 7.8±2.1 pg/mL. In 4 observations the cause of the crisis was cancer of perithyroid glands, in other cases benign tumors were removed. Conclusion. Hypercalcemic crisis in patients with parathyroid tumors has various clinical manifestations and can simulate emergency surgical, neurological and renal pathology. Management of the patients requires correction of calcium balance disorders, hypokalemia, severe protein-energy deficiency, acute renal failure not only before surgery, but also in the postoperative period.