Endocrine Abstracts

Introduction: Parathyroid carcinoma is a rare cause of hyperparathyroidism. In most cases, hyperparathyroidism is caused by a single benign adenoma. The vast majority of the remaining cases are caused by parathyroid hyperplasia or multiple adenomas. We present here a case of a young Filipina who presented with multiple fractures on all extremities and bilateral parathyroid adenoma.

Case presentation: A 19-year-old Filipina presented with bone pains for 7 months associated with fatigue, anorexia, weight loss and muscle weakness. Subsequently, she had multiple fractures on all extremities and fixed hard masses on the left humerus and tibia. Her past medical and family histories were unremarkable.

Investigations: Corrected calcium was elevated at 15.4 mg/dl, Phosporus was decreased at. Intact PTH (iPTH) was extremely high at 2001 pg/ml (8.5–72.5). X-ray of the extremities showed osteopenia, endosteal resorptive changes and multiple pathologic fractures. Bone biopsy revealed brown cell tumour/multifocal polyostotic giant cell tumour and negative for malignancy). Ultrasonography of the neck revealed parathyroid adenoma inferiorl of left thyroid gland measuring 2.3×1.1×1.0 cm. Ultrasound-guided FNAB revealed findings consistent with parathyroid carcinoma. She was hydrated and was given diuretic to control the severe hypercalcaemia. She underwent 3½ gland parathyroidectomy with en-bloc left thyroid lobectomy. Intraoperative findings showed a left mass with non well-circumscribed borders invading the capsule and local tissues and a right mass. Serum Calcium and iPTH immediately after OR decreased to 12.8 and 211.8 pg/ml respectively. Further reduction was noted after 24 h of surgery (iPTH, 48 pg/ml; Corrected Calcium: and 9.2 mg/dl).

Discussion/conclusion: Parathyroid carcinoma is a rare malignancy of the parathyroid glands. These tumours usually secrete parathyroid hormone, thereby producing hyperparathyroidism, which is usually severe. Surgery with en-bloc resection is the initial therapy, but when the tumour is no longer amenable to surgical intervention with intent to cure, treatment becomes focused on the control of hypercalcaemia.