Parathyroid Carcinoma Follow-up

  • Author: Lawrence Kim, MD; Chief Editor: Jules E Harris, MD   more...
 
Updated: Dec 7, 2011
 

Further Inpatient Care

  • Inpatient care is usually limited to the perioperative period or to treating refractory hypercalcemia.
  • Occasionally, other complications such as pathologic fractures may require hospitalization.
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Further Outpatient Care

  • After surgical treatment, periodic follow-up with serum calcium determinations is mandatory. If serum calcium begins to rise, elevation of parathyroid hormone level can confirm recurrence.
  • Once suspected, the location of the recurrence should be determined.
    • Neck imaging with CT scan, MRI, or ultrasound is indicated.
    • PET scanning may detect distant metastases but its accuracy in this disease is not clearly defined.
    • A chest radiograph is indicated, but a chest CT scan may reveal pulmonary metastases missed on plain radiograph.
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Inpatient & Outpatient Medications

  • Medical therapy is limited to the control of hypercalcemia (if necessary).
  • Most of the time, volume expansion with normal saline and diuresis with furosemide is adequate treatment.
  • The bisphosphonates may also be used for short-term control of the hypercalcemia but often are ineffective in long-term control in patients with metastatic disease.
  • Calcitonin may be used for short periods, usually in conjunction with a bisphosphonate. It usually loses effectiveness rapidly.
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Transfer

Because parathyroid carcinoma is rare, transfer to a tertiary care facility is warranted. This concentration of experience may hasten our understanding of this rare disease.

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Deterrence/Prevention

No preventive measures to guard against this disease are known.

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Complications

  • See complications outlined in Hyperparathyroidism.
  • Hypercalcemia is found in patients with untreated or inadequately treated parathyroid carcinoma. It is often the mechanism of death in patients with metastatic disease.
  • Postoperative hypocalcemia can be severe because of bone hunger syndrome.
  • In patients with severe bone disease, falling presents a serious hazard in the form of pathologic fractures.
  • Injury to the recurrent nerve at the time of operation may be unavoidable in some cases because of direct invasion by the tumor.
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Prognosis

  • Recurrence and death are quite common. Disease recurs after the initial operation in more than two thirds of patients. Recurrence is often delayed, sometimes for more than 20 years.
  • Overall, 5-year survival rate is 50-70%, but many die after 5 years. Often, death from other causes intervenes so death from parathyroid carcinoma may be relatively uncommon.
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Patient Education

  • Discuss the prognosis associated with the disease and its relationship to hypercalcemia.
  • Make patients aware that surgery is the only effective treatment against the tumor itself even though medical therapy may alleviate the hypercalcemia.
  • Emphasize the difficulty of diagnosis. Discuss the long-term nature of the disease even with metastases.
  • Educate the patient and family about fall prevention. This is more important as bone disease is more severe.
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Contributor Information and Disclosures
Author

Lawrence Kim, MD  Professor, Departments of Surgery and Medicine, Director of Surgical Endocrinology, University of Arkansas for Medical Sciences; Staff Surgeon, Central Arkansas Veterans Affairs Healthcare System

Lawrence Kim, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American Association of Endocrine Surgeons, American College of Surgeons, Association for Academic Surgery, Association of VA Surgeons, International Association of Endocrine Surgeons, Society of Surgical Oncology, Society of University Surgeons, and Southwestern Surgical Congress

Disclosure: Nothing to disclose.

Specialty Editor Board

Sanjiv S Agarwala, MD  Chief of Oncology and Hematology, St Luke's Cancer Center, St Luke's Hospital and Health Network; Professor, Temple University Shool of Medicine

Sanjiv S Agarwala, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Head and Neck Surgery, American Society of Clinical Oncology, Eastern Cooperative Oncology Group, and European Society for Medical Oncology

Disclosure: BMS Honoraria Speaking and teaching; Novartis Consulting fee Consulting; Merck Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Wendy Hu, MD  Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center

Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine; Consulting Staff, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

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Photomicrograph of parathyroid carcinoma showing typical fibrotic septae. Histologic diagnosis can be difficult.
 
 
 
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