Emergency parathyroidectomy under combined superficiaand intermediate cervical plexus block: A fatal case of hypercalcemic crisis due to parathyroid carcinoma

Hypercalcemic crisis is a rare but fatal condition. This condition may occur primarily due to primary hyperparathyroidism caused by parathyroid adenoma or rarely parathyroid carcinoma. In surgical treatment, parathyroidectomy and additional procedures are often performed with general, local and regional anesthesia. We present a case of a 71-year-old white woman with a hypercalcemic crisis associated with a possible preoperative parathyroid carcinoma. Serum calcium and parathyroid hormone levels were 18.8 mg/dl and >1900 pg/ml, respectively. Emergency left lower parathyroidectomy was performed only under locoregional anesthesia because of existing comorbidities. There was a rapid decrease in parathyroid hormone levels immediately after surgery. Histology revealed a 3 cm parathyroid carcinoma in our patient. Definitive surgery was planned and the patient was discharged. Excision in hypercalcemic crisis due to parathyroid adenoma, ipsilateral thyroid lobectomy and removal of abnormal lymph nodes in case of carcinoma is recommended. In our patient, emergency parathyroidectomy was preferred instead of definitive surgery in the first stage because of comorbidities. This case raises awareness of the life-threatening hypercalcemic crisis and emphasizes the importance and benefit of emergency parathyroidectomy and alternative anesthesia techniques in hypercalcemic crisis. © 2021, Kuwait Medical Association. All rights reserved.