Successful palliation of hypercalcemia secondary to metastatic parathyroid cancer: an unusual indication for hepatic resection

Abstract

Primary carcinoma of the parathyroid gland is a rare disease. It is often diagnosed after recurrence of hyperparathyroidism following resection for presumed adenomatous disease. Local and distant recurrence is high and aggressive resection is advocated. Patients with parathyroid cancer are frequently plagued by severe hypercalcemia, which is often refractory to medical therapy. Herein we describe the case of a patient with metastatic parathyroid cancer localized to the liver. The patient was treated with a palliative hepatic resection for the management of persistent and refractory hypercalcemia. Intraoperative parathyroid hormone levels were utilized as an adjunct to determine successful metastatectomy. Our case highlights the importance of an aggressive approach to patients with metastatic parathyroid cancer, as well as the utility of intraoperative parathyroid hormone levels to confirm successful extirpation of disease.

Resistant hypercalcaemia in metastatic parathyroid carcinoma

“…The mainstay of treatment is surgical resection, even in metastatic disease. The disease is often refractory to medical management, leading to morbidity and mortality due to hypercalcaemia rather than metastatic disease; thus, an aggressive approach to resection has been advocated 3 . Managing life‐threatening hypercalcaemia and controlling a relatively indolent tumour pose a significant therapeutic challenge in inoperable disease 4…”

“…The disease is often refractory to medical management, leading to morbidity and mortality due to hypercalcaemia rather than metastatic disease; thus, an aggressive approach to resection has been advocated. 3 Managing lifethreatening hypercalcaemia and controlling a relatively indolent tumour pose a significant therapeutic challenge in inoperable disease. 4 The efficacy of cinacalcet in the management of parathyroid cancer-related hypercalcaemia was assessed in an open-label single-arm study of 29 patients.…”

Parathyroid Carcinoma

“…The frequency of intentional sacrifice of the recurrent laryngeal nerve is higher in repeat operations than in initial operations. Metastatectomy [107] is carried out routinely if the disease is limited and technically resectable. Mediastinal lymphadenectomy, and open or thoracoscopic lung resections are the most common procedures in the chest.…”

Current and Future Treatments for Parathyroid Carcinoma

“…Long-term survival is possible, and routine surveillance can help identify early recurrence of disease [46,47]. Disease recurrence can be treated with surgical resection, if it is anatomically feasible.…”

“…Many patients with PC may undergo multiple resections, both for disease in the neck as well as for distant metastatic disease. Hepatic and pulmonary metastases have been successfully resected as palliative measures [47,48]. Complete clearance of disease remains the ultimate goal, and surgery remains the most effective treatment for recurrent disease.…”