Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Associated with profound hypercalcemia +++ Epidemiology + • Found in 0.5-1% of patients with hyperparathyroidism• Cancer is palpable in 50% of the patients• 5% of parathyroid cancers are nonfunctional• Patients with parathyroid cancer are on average younger at the time of diagnosis than patients with benign hyperparathyroidism• Equal distribution among men and women +++ Symptoms and Signs + • Palpable neck mass• Hoarseness• Fatigue, depression, nausea, vomiting, dehydration, polydipsia, polyuria• Pathologic fractures• Nephrolithiasis (70% of patients)• Nephrocalcinosis• Severe renal dysfunction (20-50% of patients)• Pancreatitis and peptic ulceration (10-15% of patients) +++ Laboratory Findings + • Profound hypercalcemia• Elevated intact parathyroid hormone (PTH) + • Parathyroid carcinoma is suspected at operation if parathyroid is hard, whitish, has an irregular capsule, or is invasive• Rarely diagnosed preoperatively + • Physical exam• PTH and calcium levels• Chest and neck CT scan + • Anecdotal evidence for role of radiation therapy in local control of disease +++ Surgery + • Surgical resection is mainstay of treatment• En bloc resection should be carried out where possible (including ipsilateral thyroid lobe and central compartment lymph nodes)• Resection of local recurrent or metastatic disease is recommended if possible +++ Indications + • All parathyroid carcinomas should be resected +++ Radiation + • Anecdotal evidence for role of radiation therapy in local control of disease +++ Medications + • Palliative drug: IV bisphosphonate to maintain eucalcemia +++ Treatment Monitoring + • Physical exam• Serum calcium and intact PTH levels +++ Prognosis + • Indolent malignancy, with local and distant metastases occurring over many years• 5-year survival rates range from 40% to 69% +++ References ++Shattuck TM et al: Somatic and germ-line mutations of the HRPT2 gene in sporadic parathyroid carcinoma. N Engl J Med 2003;349:1722. [PubMed: 14585940] Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth