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August 1980

Parathyroid Storm

Author Affiliations

From the Unit of Mineral Metabolism, Division of Endocrinology, Department of Medicine (Drs Bayat-Mokhtari and Palmieri), and Department of Neurology (Dr Pourmand), University of Tennessee Center for the Health Sciences; and the Division of Nuclear Medicine (Dr Moinuddin), Baptist Memorial Hospital, Memphis.

Arch Intern Med. 1980;140(8):1092-1095. doi:10.1001/archinte.1980.00330190104031

• Primary hyperparathyroidism frequently has a chronic and relatively benign course. Occasionally, however, it may have a stormy presentation requiring prompt adequate diagnosis and urgent surgical treatment. We describe a 71-year-old woman who had severe hypercalcemia, seizures, and coma refractory to treatment with anticonvulsant drugs, intravenous infusion of normal saline, furosemide, glucocorticoids, calcitonin, and hemodialysis. Bone roentgenograms were normal, but a strikingly positive bone scan that also showed marked soft-tissue uptake prompted the diagnosis of primary hyperparathyroidism and the successful surgical removal of a large parathyroid adenoma. This was followed by a remarkable recovery and marked reduction in soft-tissue radioactive uptake on bone scan. The association of hypercalcemia and seizures and the diagnostic value of bone scanning are discussed. An up-to-date review of the literature is presented. We proposed this condition to be named "parathyroid storm" on tne basis of the rapid and lethal course unless surgery is performed without delay.

(Arch Intern Med 140:1092-1095, 1980)