Endocrine Abstracts

Background: Parathyroid carcinoma is a very rare cause of primary hyperparathyroidism. We aimed to present a case of middle-aged man, who was initially misdiagnosed as parathyroid adenoma, with parathyroid carcinoma and severe bone deformities associated with hyperparathyroidism.

Case: A 36-years old male presented with leg aches and severe hypercalcemia in 2001, when he was diagnosed with primary hyperparathyroidism (corrected serum calcium 18.5 mg/dL (8.4–10.2), parathyroid hormone 400 pg/ml (8–76)). Total spine MRI demonstrated lytic lesions in all thoracal and lumbar vertebra. A parathyroid adenoma (28×20 in diameter, lower right part) was excised. In March 2008, he presented with generalized leg aches and gait disturbances associated with multiple pathological fractures (Figure 1) when his serum calcium was 15.6 mg/dl. Total parathyroidectomy, total thyroidectomy and thymectomy performed. Histopathological examination revealed a parathyroid carcinoma in three different focuses, with an invasion to the adjacent perineural, vascular and lymphatic tissues. He lost his follow-up once again until October 2010, when he presented with malaise, fatigue, gait disturbances and end-stage renal disease. His calcium was 16.5 mg/dl, PTH 1497 pg/ml, serum creatinine 5.5 mg/dL. Radiography of the right femur and hemipelvis demonstrated generalized Brown tumors which are huge and incorporated in distal femur giving it the form of ‘woven bone’, associated with osteitis fibrosa cystica. Neck ultrasonography showed an irregular shaped parathyroid lesion (17×14 mm), with a surrounding pathological lymph node (14×8 mm). He died of myocardial infarction when he was being prepared for another neck exploration surgery.

Conclusion: In patients presenting with severe hypercalcemia associated with hyperparathroidism, the probability of parathyroid carcinoma must be excluded, in order to avoid a catastrophic bone involvement and mortality associated with hyperparathyroidism severe deformities involving the long bones.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Figure 1.