Endocrine Abstracts

A 35 year old woman presented with severe bone pain, body aches, progressive deformities of chest, skull and swelling of hands for two years. Past history included bilateral total hip replacement for fracture of neck of femur one year back. She was normotensive and normo-glycemic. Her dietary consumption of calcium and vitamin D and sun-exposure was adequate. Investigation revealed haemoglobin 5.4gram per deciliter. Serum calcium and serum iPTH levels were elevated at 3.6milimoles per litre and 2847 nanogram per litre respectively. Skeletal survey revealed severe subperiosteal resorption of hands including a large cystic bone lesion (brown tumour) on right second metacarpal, diffuse osteolytic lesions in skull, clavicle and ribs. Ultrasound (USG) abdomen revealed bilateral renal stones. USG neck revealed enlarged right inferior parathyroid gland 3.73x1.86x1.69 centimeters. She received 6 units blood transfusion and required prolonged hospital stay for nutritional support. Per-operatively, the gland was localised adherent to carotid sheath and removed en bloc (gland weight 10.2gram) and other parathyroids biopsied. Post-operatively, she manifested features of hungry bone syndrome and needed calcium gluconate infusion for 4 weeks. Histological examination revealed trabecular arrangement of spindle shaped cells with mitotic features and evidence of capsular invasion suggestive of parathyroid carcinoma. At 6-month, her bone pain and other constitutional symptoms improved remarkably, hand swellings reduced in size and she could walk with support. There was no evidence of local or systemic recurrence of tumor. She is scheduled for radiotherapy to the tumor bed.

Parathyroid cancer is a rare cause (<1%) of primary hyperparathyroidism. The diagnosis is rarely contemplated pre-operatively. Caution should be taken during tumour removal to prevent local recurrence (50%)