Case reportConcurrent sporadic parathyroid adenoma and carcinoma
Introduction
Because localizing studies for parathyroid disease do not detect all tumor foci, we advocate the use of routine localizing studies in combination with an intraoperative parathyroid hormone assay to help identify all diseased glands. This case highlights the difficulties in diagnosing and managing parathyroid disease. Advances in technologies have shown promise for accurate diagnosis and have been leading the field toward minimally invasive parathyroid surgery. However, parathyroid surgeons must have as part of their armamentarium the art of 4-gland exploration, which is still the gold standard of parathyroid surgery and should be used when the surgeon encounters a patient in whom none of the physiological tests seem applicable.
Section snippets
Case report
A 70-year-old man was noted to have an elevated serum total calcium level of 13.2 mg/dL (normal range, 8.5–10.5 mg/dL) on routine blood work. He denied fatigue, weakness, anorexia, depression, bone pain, abdominal pain, or constipation. He had no history of kidney stones. He did have a history of childhood radiation exposure to the neck for the treatment of acne. His workup included a sestamibi scan, which revealed focal uptake in the region of the inferior pole of the right lobe of the thyroid
Comment
Primary hyperparathyroidism usually occurs as a sporadic disorder commonly caused by a solitary parathyroid adenoma (87%) or parathyroid hyperplasia (12%) [1]. Parathyroid carcinoma accounts for 0.5% to 4% of patients with primary hyperparathyroidism [2]. The sporadic concurrence of parathyroid carcinoma and parathyroid adenoma is extremely rare. There have been reported in the literature 3 cases of parathyroid carcinoma arising in a background of parathyroid hyperplasia [3], [4], [5] and 1
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Cited by (4)
Parathyroid carcinoma: clinical presentation and management
2009, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :In 1 case, the ipsilateral thyroid lobe was resected en bloc with the parathyroid mass due to local infiltration that was recognized intraoperatively. Patients with suspected PC should undergo exploration of all remaining parathyroid glands because it can coexist with adenomas or hyperplasia [11,15]. Recurrent hypercalcemia implies relapse of PC.
Parathyroid carcinoma
2012, Interni Medicina pro PraxiClinical presentation, staging and long-term evolution of parathyroid cancer
2010, Annals of Surgical Oncology