Hypercalcemic Crisis Resulting in Acute Kidney Failure

Abstract

A 56-year-old woman presented with excessive vomiting and weakness and developed ARF. She had to be hemodialyzed and was also given steroids. She was then detected to have elevated calcium (17.2 mg/dL) and was diagnosed to be having hypercalcemic crisis. Subsequently she was found to have elevated PTH as well (1341 pg/mL) and low vitamin D (19.7 ng/mL). So, a diagnosis of PHPT-induced hypercalcemic crisis was made. USG and CECT suggested a left inferior adenoma while MIBI was reported as double adenoma. Prior to surgery, her serum calcium was 10.5 mg/dL. In view of discordant imaging she underwent bilateral exploration. At operation, left inferior adenoma was found while the other 3 glands were normal. The adenoma was inseparable from the thyroid so an en bloc excision with hemithyroidectomy was done. The hemithyroidectomy-adenoma specimen weighed 13.4 gm. The HPE was benign parathyroid adenoma (Figs. 1 and 2).

The teaching point of the case is that the patient survived such extreme hypercalcemia and had complete recovery of renal functions after parathyroidectomy.

Amit Agarwal is the lead author of this chapter.