Parathyroid Carcinoma Clinical Presentation

Updated: Aug 29, 2018
  • Author: Lawrence Kim, MD, FACS, FACE; Chief Editor: Neetu Radhakrishnan, MD  more...
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Presentation

History

The presence of severe primary hyperparathyroidism and significantly elevated serum calcium and parathyroid hormone levels should trigger a high index of suspicion for parathyroid cancer and possible germline CDC73 mutation. Hyperparathyroidism–jaw tumor (HPT-JT) should be considered when the patient's family history includes benign or malignant parathyroid disease and/or fibro-osseous jaw tumors. [1]  

The history should focus on symptoms of hypercalcemia plus the other symptoms of hyperparathyroidism. The onset is usually more abrupt, and the symptoms more severe, than with hyperparathyroidism due to benign disease.  Manifestations include the following:

  • Bone pain, pathologic fracture, or other evidence of bone disease (approximately 90% of patients)
  • Renal stones (50-80% of patients)
  • Symptoms of hypercalcemia - Fatigue, weakness, confusion, depression, constipation
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Physical Examination

A palpable mass in the neck is present in approximately 50% of patients with parathyroid carcinoma. In contrast, a palpable neck mass is virtually never present with benign parathyroid adenomas or hyperplasia. Signs of hypercalcemia may also be present.

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