Endocrine Abstracts

We present a rare case of hypercalcaemia caused by a parathyroid carcinoma.

An asymptomatic 74 year old gentleman was referred with slightly raised alkaline phosphatase and corrected serum calcium the results of which are shown below:

Serum Calcium 3.02 mmol/l, Albumin 41 g/l, PTH 18.7 pmol/l, Urine Calcium 10.6 mmol/24 h, TSH 6.3 Mu/l, FT4 12.3 pmol/l, FT3 5.1 pmol/l, TPO antibody >5000 IU/ml, ALP 142 iu/l.

An isotope scan of parathyroid demonstrated a parathyroid adenoma near the mid to lower pole of the left lobe of thyroid. He was diagnosed with parathyroid adenoma and sub clinical hypothyroidism. As his calcium continued to be raised, he was referred to a surgeon and a large parathyroid adenoma, which was somewhat irregular, and adherent to the local tissues was removed.

Histology revealed a parathyroid carcinoma. The case was discussed at the regional thyroid MDT meeting and it was decided that he would need a total thyroidectomy, level 6 lymph node neck dissection and further scans to search for any metastases.

CT chest and MRI of his neck and mediastinum showed no evidence of any metastatic disease. His calcium normalised post surgery and he remained asymptomatic.

Following the results of the scan, there was disagreement at the regional MDT as to further management. As he was asymptomatic, normocalcaemic and there was no evidence of metastases, a decision was taken to treat him conservatively. Furthermore the patient was not keen for further intervention. Five months post surgery, the patient remains well and normocalcaemic.

A review of the literature on the management of parathyroid carcinoma will also be discussed.