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A. Pallauf, J. Schopohl, M. Makeschin, T. Kirchner, M. Reincke, Lethal Generalized Calcinosis and Hypercalcemic Crisis in Primary Hyperparathyroidism, The Journal of Clinical Endocrinology & Metabolism, Volume 100, Issue 1, 1 January 2015, Pages 17–18, https://doi.org/10.1210/jc.2014-2813
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We report on a 40-year-old male admitted to our intensive care unit with severe hypercalcemia, somnolence, and shortness of breath. Over the preceding 2 years he had developed progressively polyuria and polydipsia. The patient consulted a urologist and was diagnosed with an overactive bladder. Normal plasma glucose levels excluded underlying diabetes mellitus. Serum calcium concentrations, however, were never measured. On admission, lab findings were consistent with severe PTH-mediated hypercalcemia (calcium 6.6 mmol/L; potassium 2.7 mmol/L; intact PTH 4880 pg/mL; 25-hydroxyvitamin D <10 ng/mL; calcium-phosphate-product 9 mmol2/L2), oliguric renal failure (creatinine 3.8 mg/dL), and respiratory failure. The patient required invasive ventilation and hemodiafiltration. Sonography and computed tomography visualized a 5-cm left-sided retrosternal tumor suggestive of parathyroid adenoma. Intravenous fluids, bisphosphonates, cinacalcet, denosumab, and hemodialysis were initiated to treat hypercalcemia. Calcium levels decreased but could not be normalized. The patient developed multiorgan failure before parathyroidectomy could be performed and died from refractory shock on day 4.
