ABSTRACT
A parathyroid crisis is characterized by a severe elevation in calcium, usually above 14-15 mg/dl alongside acute signs and symptoms of hypercalcemia. It is a rare but potentially life-threatening complication of primary hyperparathyroidism (PHPT). Among all primary hyperparathyroidism cases, parathyroid carcinoma accounts for only less than 1%. Although the definitive management is surgical parathyroidectomy, the exact timing of surgery is not well-established. We describe a case of a patient with abrupt onset of severe hypercalcemia who was managed medically and discharged for elective parathyroidectomy. This was because her workup was suspicious for parathyroid carcinoma, and there was a need to pursue a positron emission tomography (PET)-computed tomography (CT) scan to evaluate for other malignancies before proceeding with parathyroidectomy. The patient experienced the resolution of her symptoms of acute encephalopathy and improvement in her calcium levels from 22.3 mg/dl (8.8-10.2 mg/dl) on admission to 9.1 mg/dl on day 13 of hospitalization and discharge. In this report, we review the literature on the timing of parathyroidectomy in patients with a parathyroid crisis and how this has evolved over time with the use of new hypocalcemic agents. We discuss that parathyroidectomy performed emergently within 72 hours vs after 72 hours has not shown any significant impact on long-term survival in patients with parathyroid crisis. Moreover, medical management is crucial while waiting for surgery.
ABSTRACT
Since 2019, COVID-19 has plagued the world with its unfortunate death toll; however, with the introduction of multiple COVID vaccines, mortality and morbidity rates have severely declined. There have been misconceptions surrounding these vaccines, and at the same time, many documented conditions precipitated by the vaccines. This case highlights a speculated relationship between new-onset Latent Autoimmune Diabetes in Adults (LADA) (presenting with diabetic ketoacidosis) and the COVID-19 vaccine. There have been articles suggesting the precipitation of diabetic ketoacidosis /hyperosmolar hyperglycemic syndrome, as well as new-onset diabetes mellitus (DM) with the COVID-19 vaccines but no documented link between LADA and the vaccine. The endpoint of this case is not only to highlight a newfound side-effect of the vaccine but also to urge primary care providers and physicians to closely monitor glucose levels and patient's A1C after vaccine administration to prevent the formation of these hyperglycemic crises, as well as to consider autoimmune conditions in the differential diagnosis post-vaccination.
