Endocrine Abstracts

Introduction: Parathyroid carcinoma is a rare malignancy of the parathyroid glands. Parathyroid carcinoma may be suspected, but it usually cannot be confirmed prior to operation.

Case: A 35-year-old male was consulted to Endocrinology department with persistant kidney stones. He was operated five times in 10 years for recurrent kidney stones.

His lab results are as follows; Ca:13(8.8–10.6), P:2.2 mg/dl(2.5–4.5), ALP:84U/L(30–120), parathormone:179 pg/ml(14–72), 25(OH)Dvit:8.2 ug/l(10–80). Urine Ca: 1159 mg/24 h(100–300), urine P:134 mmol/24 h(13–42).

Neck USG revealed 17×11×12 mm PTH adenoma with cystic components, but with no pathological cervical lymphodenopathies.

Radionuclide scan confirmed increased parathyroid gland activity on the right inferior of the thyroid gland.

The patient underwent right inferior parathyroidectomy. Postoperative PTH<6, Ca:8.17,which confirmed successful remove of the pathological parathyroid gland.

The histological findings reported marked pleomorphysm in the cells, divided by the typical fibrotic septae and Ki-67: 4–5%. All those findings were consistent with parathyroid carcinoma.

After 4 months his last lab results were as follows; PTH: 57.8 pg/ml, Ca:8.8 mg/dl, P:4.6 mg/dl, urine Ca: 124 mg/24 h.

Conclusion: There is a challenge in the diagnosis of parathyroid carcinoma, because it is commonly confirmed with histological evaluation. Although, parathyroid carcinoma is a rare disease, it should be kept in mind even in young adults.