ECE2022 Poster Presentations Calcium and Bone (68 abstracts)
Extreme hypercalcemia due to primary hyperparathyroidism– a look-back on over a decade in a tertiary care center
Reut Halperin , Yair Schwartz , Yehudit Eden-Friedman , Genya Hananel , Roi Shalit , Pini Klein , Ehud Barhud , Rina Hemi , Iris Vered & Liana Tripto-Shkolnik
Sheba Medical Center, Division of Endocrinology, Diabetes and Metabolism, Tel Hashomer, Israel
Background: Extreme hypercalcemia is an endocrine emergency. Given parathyroid hormone (PTH)-dependent cause, carcinoma should be suspected as a possible etiology. The prevalence of parathyroid carcinoma among patients presenting with extreme hypercalcemia is not well elucidated.
Aim: Establish proportion of patients with parathyroid carcinoma among those presenting with severe hypercalcemia and compare clinical and laboratory features between benign and malignant etiologies.
Methods: Admissions during 2009-2021 with serum calcium ≥14 mg/dl were identified via MD-clone platform. Cases with PTH< mid-reference range or serum creatinine > 1.5 mg/dl were excluded. Clinical, biochemical and histological data were retrieved.
Results: Twenty-seven patients meeting an inclusion criteria were identified (44% males). Those constitutes 5.3% percent of severe hypercalcemia hospitalized during 2009-2021. Calcium level was 15.3±0.3 mg\dl and PTH level 461±66 pg\ml. Twenty patients (74%) were symptomatic (constipation, polyuria/polydipsia, change in mental status). Eleven (40%) had a precipitating event. Ten (37%) patients were referred due to abnormal laboratory. Twenty-one underwent parathyroidectomy, with pathology of adenoma/hyperplasia in 19 and carcinoma in 2 cases. Long-term (up to 6 years) follow-up of 2 non-operated patients suggests benign etiology. Levels of PTH, calcium, albumin and creatinine were indistinguishable between etiologies. Age at presentation was 78 and 79 years for carcinoma compared with 57.6 years (19-82 years) in the adenoma\hyperplasia group.
Conclusions: Severe hypercalcemia is uncommon and PTH-dependent etiologies constitute a minority of those. Benign parathyroid disease was the most common etiology of severe PTH-dependent hypercalcemia. Due to the extreme rarity of parathyroid malignancy, significant clinical or laboratory predictors were not identified.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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