Treatment of Primary Hyperparathyroidism with Markedly Elevated Serum Calcium — Hypercalcaemic Crisis and Parathyroid Storm

This protocol covers primary hyperparathyroidism (PHPT) presenting as a hypercalcaemic crisis — also termed parathyroid storm or acute hyperparathyroidism — characterised by markedly elevated serum calcium (e.g. ≥3.0 mmol/L), with or without multiorgan dysfunction.

Clinical Setting

Patients with PHPT who develop an intercurrent illness or become dehydrated are at risk of hypercalcaemic crisis. This state can result in symptomatic hypercalcaemia and multiorgan dysfunction requiring urgent inpatient intervention.

Management Approach (overview only)

Inpatient management addresses the precipitating illness alongside restoration of fluid and electrolyte balance. Medical strategies are employed to reduce serum calcium, with definitive surgical management considered once adequate medical optimisation has been achieved.

The complete stepwise regimen — including specific agents, sequencing, and surgical criteria — is available in the full protocol.

Treatment Goals

Adequate urine output and a demonstrable fall in serum calcium following fluid resuscitation and therapy.

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References

DOI: 10.1111/cen.14650

However, other patients with symptomatic hypercalcaemia with or without organ dysfunction may require urgent medical intervention.
Hypercalcaemic crisis, acute hyperparathyroidism or parathyroid storm may be induced in a patient with PHPT and intercurrent illness or dehydration, and can result in multiorgan dysfunction.
2) restoring fluid/electrolyte balance (3–4 L/24 h normal saline in the absence of contraindications);
5) parathyroidectomy once safe to proceed.
4) promoting renal calcium excretion and ensuring adequate urine output.

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