Monitoring
Hyperparathyroidism_Follow UpAnnual serum calcium, parathyroid hormone, creatinine, and eGFR assessment are recommended. The parathyroid hormone may not be measured in normocalcemic patients following surgery. A three-site dual-energy X-ray absorptiometry scan should be done every 1-2 years. Bone mineral density assessment should be performed every 1-2 years in cases of chronic disorder. Radiograph or vertebral fracture assessment done in patients suspected of having vertebral fracture (ie back pain, height loss, new-onset back pain). A 24-hour biochemical stone profile for suspected cases of renal nephrolithiasis or nephrocalcinosis. Abdominal imaging with radiography, CT, or ultrasound is recommended in patients suspected with renal nephrolithiasis or nephrocalcinosis.
Complications
Complications of hypercalcemia include osteoporosis, bone pain, bone fractures, kidney stones, renal disease or failure, stomach ulcers, and pancreatitis.
In rare cases, parathyroid crisis, also known as parathyroid poisoning, parathyroid intoxication, parathyroid storm, or hypercalcemic crisis may occur. This is characterized by the sudden onset of life-threatening hypercalcemic episodes (very high serum calcium levels, 20x above normal parathyroid hormone levels) and severe hypercalcemia-associated clinical manifestations. This requires aggressive fluid resuscitation at a rate of at least 200 mL/hr of saline to promote renal calcium excretion and intravascular volume restoration. Once rehydrated, diuresis or dialysis with no or low calcium-containing dialysate may be added to inhibit reabsorption of calcium as long as blood pressure remains stable.
In rare cases, parathyroid crisis, also known as parathyroid poisoning, parathyroid intoxication, parathyroid storm, or hypercalcemic crisis may occur. This is characterized by the sudden onset of life-threatening hypercalcemic episodes (very high serum calcium levels, 20x above normal parathyroid hormone levels) and severe hypercalcemia-associated clinical manifestations. This requires aggressive fluid resuscitation at a rate of at least 200 mL/hr of saline to promote renal calcium excretion and intravascular volume restoration. Once rehydrated, diuresis or dialysis with no or low calcium-containing dialysate may be added to inhibit reabsorption of calcium as long as blood pressure remains stable.