A case of parathyroid crisis presenting with multisystem injury and persistent hypercalcemia posing multidisciplinary critical care challenge

Parathyroid crisis is a rare but life-threatening endocrine emergency characterised by severe hypercalcemia and rapid progression to multiorgan dysfunction. We report the case of a 52-year-old woman who presented with vomiting and was found to have severe hypercalcaemia (corrected calcium 21.8 mg/dL) and elevated parathyroid hormone (224 pg/mL). Imaging confirmed parathyroid adenomas, and she underwent emergency resection of three adenomas. Within 24 hours, parathyroid hormone levels normalized (21 pg/mL); however, hypercalcemia persisted, complicated by oliguric acute kidney injury requiring hemodialysis and oral cinacalcet treatment. Postoperatively, she developed respiratory failure with left lower lobe collapse, necessitating intubation and repeated bronchoscopic clearance of mucus plugs. She experienced transient episodes of bradycardia and asystole, managed with isoprenaline infusion and temporary pacing. Her course was further complicated by sepsis due to carbapenem-resistant Acinetobacter baumannii, treated with targeted antibiotics. Persistent neuromuscular weakness led to diagnosis of critical illness polyneuropathy. She underwent tracheostomy, was gradually weaned to a portable ventilator, and was discharged after intensive physiotherapy with normalised serum calcium levels on cinacalcet. This case highlights the potential for extensive systemic injury in parathyroid crisis and underscores the need for vigilant post-operative monitoring and timely recognition of complications. Aggressive multidisciplinary management can result in full recovery even in critically ill patients.