Endocrine Abstracts

Introduction: About 1% of primary hyperparathyroidism is due to parathyroid carcinoma. The affected gland is often indistinguishable from atypical adenoma. The proper diagnosis is usually made when the disease recurs or metastases are present and then is connected with poor prognosis.

Case report: A 49-year-old man, after resection of parathyroid adenoma (postoperatively with normalization PTH concentrations and hungry bone syndrome), with limbs’ fractures due to fall from his height, was admitted to Department of Endocrinology because of high serum levels of PTH (913 pg/ml; n,14–72) and calcium (13.0 mg/ml; n,8.4-10.4). MIBI and CT scans showed enlarged lower right parathyroid gland. Reoperation and total strumectomy of the right lobe was performed but the decrease in PTH and calcium levels have not been observed. Few weeks later, Ca and PTH increased to 17.7 mg/dl and 2910 pg/ml respectively. Additionally left kidney nephrolithiasis, brown tumours of the iliums and in the skull have been observed. 18-FDG PET–CT showed metabolic active lesion on the left side of the trachea which has been removed. Histological postoperative examination confirmed the suspected diagnosis of parathyroid carcinoma. After short-term improvement, PTH and calcium concentrations increased again (PTH, 5570 pg/ml; Ca, 16.8 mg/dl). The check-up CT revealed reccurent peritracheal patological mass (19×25×30 mm) with the impression of the oesophagus. After fourth non-radical surgery, decrease but not normalization in PTH and Ca levels have been achieved. The patient was disqualified from radio- and chemotherapy. To manage hypercalcaemia, besides typical treatement, zoledronic acid, pamidronian, and cinacalcet have been used. Unfortunately, renal impairment, swallowing disturbances, and dyspnea have been appeared. Twelve months later after the diagnosis of primary hyperparathyroidism the patient died beacause of respiratory and cardiac failure.

Conclusions: Rare prevalence of parathyroid cancer, lack of typical symptoms and histological features usually cause delay in diagnosis that deteriorates prognosis. Therefore parathyroid carcinoma still remains diagnostic and management challenge for many physicians.