Management of acute hyperparathyroidism in a community hospital

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Abstract
Primary hyperparathyroidism is a common entity that routinely lends itself to prompt surgical cure. Infrequently, multiple surgical explorations are required to effect a cure. A case is reported of a 27 yr old man with hypercalcemia and nephrocalcinosis. The initial surgical exploration failed to identify the abnormal parathyroid tissue. Hypercalcemia necessitated rigorous antihypercalcemic therapy; 3 subsequent operations, including a mediastinal exploration, were unsuccessful. On the 5th exploration, which took barely an hour, a 35 g adenoma was removed from the left superior posterior mediastinum. A detailed knowledge of the possible locations of aberrant parathyroid tissue and the skills of the operating surgeon are the sine qua non for those patients requiring 1 or more parathyroid reexplorations.

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