Parathyroid carcinoma: Challenges in diagnosis and management

Dr. Nusrat Sultana
Assistant Professor of Endocrinology
Department of Endocrinology
Bangabandhu Sheikh Mujib Medical University
Dhaka, Bangladesh

Abstract

Parathyroid carcinomas are a rare cause of primary hyperparathyroidism. Although the patients are usually presented with distinct clinical and biochemical features of severe hypercalcemia, there is an overlap in the presentation with benign parathyroid disease. Severe hypercalcemia is common but some patients remain normocalcemic and often present with a neck mass only. Non-functioning parathyroid carcinoma is rare and increases the chance of missed diagnosis. Localization studies do not reliably distinguish parathyroid carcinoma from adenoma. The diagnosis of parathyroid carcinoma is typically made at the time of surgery. In some cases, it may not be possible to differentiate parathyroid adenoma from carcinoma at the time of initial surgery. A simple histological examination often misses the diagnosis. Management poses another challenge. Surgical resection is the optimal treatment. However, there remains no consensus on the optimal extent of surgery.

Keywords: Parathyroid carcinoma; Hyperparathyroidism; Hypercalcemia