Endocrine Abstracts

Aim: To determine clinical predictors of parathyroid gland carcinoma recurrence.

Methods: We evaluated outcome of eight patients with primary hyperparathyroidism due to parathyroid carcinoma who were followed at University Hospital Centre Zagreb in period from 2004 to 2014. The median follow-up was 6 (range 2–14.5) years. Six patients (three male, three female; median age 57.5 (42–71) years) experienced long-term remission after the surgery whereas two patients had unfavourable course of the disease. In patients with remission hypercalcaemia was known in median for 4 (1–16) years before the surgery. At the time of diagnosis median PTH was 48 (24–147) pmol/l (normal value 0.2–6.7 pmol/l). All of them had renal impairment, hypertension and osteoporosis with two of them previous fractures. Following surgery hypocalcaemia rapidly developed requiring intravenous calcium replacement and prolonged hospital stay. Two female patients (age at diagnosis 31 and 32 years) had poor disease outcome. Their initial diagnosis was established on the basis of acute complication of hypercalcaemia; one of them was pregnant and her newborn had severe neonatal hypocalcaemia whereas another patient had episode of acute pancreatitis. Formerly they had no recognized comorbidities related to hypercalcaemia with the exception of osteoporosis without fractures. Their PTH values were 72 and 36 pmol/l and serum calcium concentrations 4.03 and 3.8 mmol/l respectively. Following surgery there were no clinical manifestations of hypocalcaemia and no need for intravenous calcium supplementation. Within 1 year hypercalcaemia reoccurred and metastatic disease was confirmed. In both patients multiple endocrine neoplasia was excluded and chromogranin was repeatedly negative.

Conclusion: Younger age, lack of chronic consequences of hypercalcaemia and hyperparathyroidism, no signs of sever symptomatic hypocalcaemia following surgery and no need for postoperative calcium supplementation could be clinical predictors of parathyroid gland carcinoma recurrence.