Question
A patient presents with a parathyroid crisis (hypercalcemic crisis) with a serum calcium level of 16 mg/dL. Which of the following is the most appropriate management?
| A. |
Intravenous Vitamin D
|
| B. |
Emergency parathyroidectomy
|
| C. |
Calcitonin therapy
|
| D. |
Intravenous hydration followed by calcitonin and definitive parathyroidectomy
|
Show Answer
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Correct Answer » D
Explanation
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|
Parathyroid crisis (hypercalcemic crisis) is a life-threatening complication of severe hyperparathyroidism characterized by:
- Serum calcium usually >14–16 mg/dL
- Severe dehydration
- Nausea and vomiting
- Altered mental status
- Cardiac arrhythmias
- Acute kidney injury
The most common cause is primary hyperparathyroidism due to a parathyroid adenoma.
Initial (Emergency) Management
1. Aggressive Intravenous Hydration
- First and most important step.
- Normal saline corrects dehydration and increases urinary calcium excretion.
2. Calcitonin
- Rapid onset of action (4–6 hours).
- Inhibits osteoclastic bone resorption.
- Provides temporary reduction in serum calcium.
3. Bisphosphonates
- Zoledronic acid or pamidronate.
- Longer duration of action.
- Often added after hydration.
Definitive Treatment
Parathyroidectomy
- Definitive treatment for parathyroid adenoma causing hyperparathyroidism.
- Usually performed after stabilization of the patient.
