Rare endocrine disorder: parathyroid carcinoma

Introduction: Parathyroid carcinoma occurs in 0.5 to 5% of cases of primary hyperparathyroidism, so it is rare among malignant endocrine disorders. Complete healing can be provided by surgical intervention with appropriate radicality. In the early stages of the disease, there are no marked clinical and cytological features that could clearly distinguish the benign form before and during surgery. Patient and Method: At the Department of Surgery University of Debrecen 362 patients had surgery for hyperparathyroidism, including 6 patients with parathyroid carcinoma between 2006-2017. All 6 patients were men (age 22-69). The size of the tumor was between 14 and 55 mm, according to pre-operative calcium (2.95-4.13 mmol / l) and parathyroid hormone (28.2-260.4 pmol / l norm: 1.6-6.9 pmol / l) was significantly elevated. Due to the suspicion of malignancy and the clinical picture, the enlarged parathyroid gland was removed with thyroid gland (lobectomy or total thyroidectomy). 30 minutes after removal, intraoperative parathormone level significantly decreased in 4 cases, 24-hour level in all 6 cases. In case of one patient a recurrent laryngeal nerve paresis has occured. During follow-up, in 5 patients noramal and in 1 case elevated PTH levels were measured with normal calcium levels. Conclusions: The complete therapy for parathyroid carcinoma is based on the radical surgical intervention. Recognition of carcinoma is therefore important (eg considerably increased calcium, parathormone level, cysticus, inhomogeneous parathyroid hypertrophy greater than 3 cm). The success of surgery is suppurted by the measurement of intraoperative parathyroid hormone level. Continuous endocrine follow-up is needed to detect recurrence in time.