a short presentation about the common symptoms of hyperparathyroidism and the general principles of treatment

1.  36 YO F with primary hyperparathyroidism
 During a routine parathyroid exploration - an
enlarged inferior parathyroid gland is found.
it appears to be adhered to the thyroid gland
and surrounding soft tissue.
parathyroid carcinoma.

2.  Parathyroid glands are located behind the
thyroid gland and control the amount of
calcium in our blood and bones

4.  Parathyroid carcinoma is a rare malignancy
of the parathyroid glands. These tumors
usually secrete parathyroid hormone,
thereby producing hyperparathyroidism,
which is usually severe.
 Primary hyperparathyroidism is the
unregulated overproduction of parathyroid
hormone (PTH) resulting in abnormal
calcium homeostasis.

5.  hyperparathyroidism -high serum calcium
levels, severe bone disease, and renal
stones
 Untreated, parathyroid carcinoma leads to
nephrocalcinosis, pathologic fractures, and
neuropsychiatric symptoms

7.  it can be difficult to diagnose parathyroid cancer
preoperatively due to clinical features shared with
benign causes of hyperparathyroidism.
 Imaging techniques such as neck ultrasound can help
localize the disease, but they are not useful in the
assessment of malignancy potential.
 Fine needle aspiration (FNA) prior to initial operation is
not recommended due to technical difficulty in
differentiating benign and malignant disease on
cytology specimens and the possible associated risk of
tumor seeding from the needle track.
 Complete surgical resection with microscopically
negative margins is the recommended treatment

8.  Blood tests-
› calcium levels are even more increased as
compared to benign primary
hyperparathyroidism.
› Increased PTH
 Imaging-
› radiography
› CT

9.  No effective medical therapy for parathyroid
carcinoma is known
 therapy is primarily geared toward
management of the hypercalcemia that is
often quite severe. Treatment is similar to
hypercalcemia due to other causes.

10.  Pre operative
› medical intervention to control hypercalcemia
› Volume expansion with isotonic saline and
diuresis with furosemide.
› any volume contraction should be corrected
before the operation.

11.  Operative
› The goal of the initial operation -remove the
tumor and any adherences to tissue, the
ipsilateral thyroid lobe, and any enlarged lymph
nodes.

12.  Postoperative
› same as for benign hyperparathyroidism.
› substantial doses of postoperative calcium
› Recurrences may happen
› Long-term cure after a recurrence is virtually
unknown.

13.  https://emedicine.medscape.co
m/article/280908-treatment#d8
 https://www.ncbi.nlm.nih.gov/p
ubmed/22327883
 https://emedicine.medscape.co
m/article/280908-workup#c3
 https://emedicine.medscape.co
m/article/280908-workup#c3
 https://emedicine.medscape.co
m/article/127351-overview#a4