Parathyroid cancer and of primary hyperparathyroidism

Mouna Elleuch; Maalej Souhir; Wissal Ghamgui; Salah Dhoha Ben; Trigui Souleima; Nadia Charfi; Mouna Mnif; Fatma Mnif; Majdoub Nabila Rekik; Fatma Hamza; Fadhel Guermazi; Akid Faten Haj Kacem; Mohamed Abid

doi:10.1530/endoabs.90.EP640

Parathyroid cancer is a rare cause of primary hyperparathyroidism (PPH). The objective of this work is to discuss clinical and therapeutic specificities of these tumors.

Case n°1

51-year-old woman from a consanguineous marriage, with a family history of recurrent renal lithiasis, neoplasia, and a personal history of breast neoplasia and uterine fibroid, consulted for abdominal pain, vomiting and weight loss. The diagnosis of primary hyperparathyroidism was made in view of hypercalcemia (3.65 mmol/l), hypophosphatemia (0.62 mmol/l), PTH=2701 pg/ml (41*N), hypovitaminosis D <8 ng/ml, Clcreatinine=86 ml/min. A left retro-thyroid nodule and 2 right sub-thyroid nodules on cervical ultrasound were noted. The Technetium-99m-sestamibi scan showed a left retro-thyroidal mass 21×16×37 mm and a right inferior latero-tracheal nodule 13×16 mm fixing MIBI. Hyperparathyroidism-jaw tumor-syndrome was strongly suspected; mandibular radiography didn’t show any ossified fibroids. The search for HRPT2 gene mutation is in progress. A left lobo-isthmectomy with homolateral mediastino-recurrential evacuation and a right and left upper parathyroidectomy were performed. anatomopathology examination revealed a 5 cm left upper parathyroid carcinoma with oxyphilic cells and 2 atypical parathyroid nodules of the right upper pole of 1.5 cm.

Case n°2

Sporadic PPH complicated by recurrent lithiasis and osteoporosis in a 68 year old man secondary to a necrotic cervical-mediastinal ectopic right lower parathyroid mass. Malignancy was suspected due to the large size (8 cm), and a PTH of 16 times normal. The patient underwent carcinological surgery and total thyroidectomy for a multinodular goiter. Anatomopathology examination is in progress

Case n°3

57-year-old patient, with a personal history of hypertension and primary infertility, consulted for incoercible vomiting, asthenia and fever. The bilogy: hypokalemia (2.7×mmol/l), renal insufficiency (clcréat=29 ml/min), hypophosphoremia (0.45 mmol/l), hypercalcemia (4.02 mmol/l) with electrical signs (QT shortening) requiring an emergency hemodialysis session. Primary hyperparathyroidism was diagnosed with a PTH=570 pg/ml (8.7*N), a plunging cystic mass with some parietal calcifications, measuring 40×56×90 mm and largely necrotic, not fixing MIBI. The evolution was marked by the appearance of epileptic seizures, followed by an alteration of his state of consciousness in relation to a Wernicke’s encephalopathy on MRI.

Endocrine Abstracts

EP640