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Invited Critique
July 1, 2006

Long-term Results of Parathyroidectomy for Hypercalcemic Crisis—Invited Critique

Arch Surg. 2006;141(7):700. doi:10.1001/archsurg.141.7.700

Not only does the study by Lew et al provide confidence in the long-term outcome of patients with hyperparathyroidism presenting in hypercalcemic crisis, it provides insight into the presentation and safe treatment of these patients, emphasizing current techniques. All of their patients certainly met the criteria for hypercalcemic crisis, with minimum serum calcium levels of 15 mg/dL (3.75 mmol/L) associated with signs and symptoms of hypercalcemic intoxication. Somewhat surprisingly, only 35% of their patients demonstrated mental status changes. Despite urgency in establishing the diagnosis, on average, 5 days elapsed between admission and parathyroidectomy—no doubt testimony to the severity of the hypercalcemia and the volume of fluid required to correct marked dehydration and facilitate excretion of the huge increased filtered load of calcium. There is definite risk of life-threatening cardiac arrhythmias if hypercalcemia is not brought under control preoperatively.1 Because the 2 principal causes are hyperparathyroidism and malignancy, discriminating between these is now usually easy and accurate by obtaining calcium and rapid parathyroid hormone values.

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