• Yuhei Koyama and Shinsuke Hamaguchi.
• Department of Anesthesiology and Pain Medicine, Dokkyo Medical University School of Medicine, Tochigi, Japan.
• Medicine (Baltimore). 2024 Aug 30; 103 (35): e39510e39510.

RationalePrimary hyperparathyroidism (PHPT), which is characterized by increased parathyroid hormone secretion, typically manifests as hypercalcemia and hypertension. Here, we report a case of severe hypotension following tracheal intubation during anesthesia induction in a patient with PHPT, in contrast to the expected hypertensive response.Patient ConcernsA 52-year-old man presented with nausea after eating, leg pain when walking, and headaches.DiagnosisBased on the blood test and computed tomography results, he was diagnosed with PHPT.InterventionsThe patient underwent parathyroidectomy under general anesthesia. After induction anesthesia and tracheal intubation, severe acute hypotension and tachycardia suddenly developed. To treat hypotensive shock, we immediately administered ephedrine and phenylephrine and infused Ringer solution.OutcomesThe symptoms of hypotensive shock were alleviated by this intervention.LessonsWe speculate that the cause of his severe hypotension was vasodilation due to the transient release of parathyroid hormone from mechanical stimulation by anesthetic procedures, such as tracheal intubation, combined with hypercalcemia-induced severe dehydration. Moreover, we speculate that fluid resuscitation stabilized his condition and helped achieve a successful surgical outcome. The possibility of severe hypotension after anesthesia induction should be anticipated, and management of cases with severe dehydration should be optimized during the anesthetic management of patients with PHPT.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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