Endocrine Abstracts

Introduction: Parathyroid carcinoma is a rare endocrine malignancy accounting for <1% of all cases of hyperparathyroidism. Diagnosis and treatment is still difficult.

Case report: A 32-year-old women was admitted to the hospital because of mental status changes, polyuria, polydipsia, musculoskeletal pain and weight loss (34 kg during last year). She had history of nephrolithiasis, pancreatitis, cholelithiasis, peptic ulcer disease, osteoporosis and diabetes. She underwent right lower parathyroidectomy (histopathology: nodular hyperplasia) 3 years before reported hospitalization. On physical examination: neck exam showed a 4 cm, hard, nodular mass in the anterior neck with lymphadenopathy. Routine blood tests revealed severe hypercalcemia (serum calcium of 4.14 (mmol/l)), elevated intact PTH (2374 pg/ml) and alkaline phosphatase (600 UI/l). Ultrasound of the neck showed enlargement lymph nodes and hypoechoic mass below of the right lower thyroid lobe (1.9×2,2 cm) suggestive of a solid nodule of the right lower parathyroid. PET scan showed additional metastases to the lymph nodes and lungs. Parathyroid carcinoma was diagnosed on histopathology after cytoreduction surgery. She underwent radiotherapy after surgery and received chemotherapy.

Conclusion: Parathyroid carcinoma is highly suggestive in young age, palpable neck mass, concomitant renal, pancreas, skeletal disease and extremely high iPTH level.