Endocrine Abstracts

Background: Parathyroid carcinoma (PC) is a rare endocrine tumour, with difficult intraoperative recognition, histological diagnosis and imprevisible evolution. More unusual are the cases appearing at the patients with end-stage renal disease on maintenance hemodialysis (22 observations in medical literature).

Case report: A 46 year-old man which suffered of chronic glomerulonephritis from 13 years, being on hemodialysis from three years, complains of asthenia, adynamia, muscle weakness, severe itching and progressive osteoarticular pains. Preoperative iPTH was 71 ng/ml, seric Ca++:1.23 mmol/l, seric Ca:2.3 mmol/l, seric P:2.02 –mmol/l. Clinical and ultrasonographical examinations revealed a left ‘thyroid nodule’ of 44/32 mm and moderate enlargement of the right sided parathyroids.

Results: At operation three parathyroid glands (two from the right side and the superior left one) was easy identified and resected after frozen section. The fourth gland was not found but the ablation of the ‘nodule’ revealed a PC confirmed by the paraffin examination. Postoperative clinical and humoral course was uneventfully and the patient continued his hemodialysis programme, being well after 20 months, without recurrence or metastasis. The recent iPTH was 5 ng/ml.

Conclusion: The authors underlined the criteria and difficulties of pathologic diagnosis of PC and the importance of the initial surgical treatment based of their experience of three cases representing 8.1% (!) in a series of 37 observations of primary and renal hyperparathyroidism operated on in the last ten years.