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A case of parathyroid carcinoma with hypercalcemia responsive to cinacalcet therapy

Nature Clinical Practice Endocrinology & Metabolism volume 2, pages 291–296 (2006)Cite this article

Abstract

Background A 54-year-old man presented to the emergency department of his local hospital with a 1-year history of fatigue, weight loss, and constipation. He had abused alcohol for many years, and his symptoms were initially attributed to alcoholism. On physical examination, he was confused, his blood pressure was normal, he had no palpable neck masses, and his liver was enlarged. His serum calcium concentration was 4.2 mmol/l and his serum parathyroid hormone concentration was 36 pmol/l. CT-guided biopsy of a liver lesion showed large neoplastic cells, and fine-needle aspiration of the neck showed cells similar to those in the liver. The patient was treated with intravenous saline, pamidronate, and zoledronic acid. He was referred to our hospital on day 35 for treatment of refractory hypercalcemia.

Investigations Sestamibi parathyroid scan, chest and abdominal CT scans, neck ultrasonography, liver biopsy, fine-needle aspiration of neck mass, and measurement of parathyroid hormone in an aspirate of the neck mass.

Diagnosis Primary hyperparathyroidism caused by metastatic parathyroid carcinoma.

Management Intravenous fluids, intravenous doses of pamidronate and zoledronic acid and oral cinacalcet therapy.

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Figure 1: Serum calcium (red line) and parathyroid hormone (blue line) concentrations in the patient described with parathyroid carcinoma
Figure 2: CT image of the neck, histology of the liver biopsy, and cytology of the neck mass in the patient with parathyroid carcinoma

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Authors and Affiliations

  1. Brigham and Women's Hospital,

    Emily D Szmuilowicz & Robert D Utiger

  2. Harvard Medical School, and Senior Physician, Brigham and Women's Hospital, Boston, MA, USA

    Emily D Szmuilowicz & Robert D Utiger

Authors
  1. Emily D Szmuilowicz
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  2. Robert D Utiger
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Correspondence to Robert D Utiger.

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Szmuilowicz, E., Utiger, R. A case of parathyroid carcinoma with hypercalcemia responsive to cinacalcet therapy. Nat Rev Endocrinol 2, 291–296 (2006). https://doi.org/10.1038/ncpendmet0189

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  • DOI: https://doi.org/10.1038/ncpendmet0189

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