Mediastinal Parathyroid Carcinoma in A Patient with Chronic Kidney Disease in Hemodialysis

Patricio Cabané
2016 Endocrinology&Metabolism International Journal  
Parathyroid carcinoma accounts for 0.5-5% of primary hyperparathyroidism, and is exceptional in Chronic Kidney Disease. It usually presents with Hypercalcemia and increased PTH. Image studies with 99Tc-sestaMIBI scintigraphy and ultrasonography are first line. Histopathological features and negative immunohistochemistry staining for parafibromin provide the definitive diagnosis. Summary: A 49-year-old male with stage 5 CKD presented with Hypercalcemia and a rapid rise in PTH levels. Image
more » ... s showed signs of parathyroid hyperplasia. After subtotal parathyriodectomy, intraoperative PTH levels did not fall, and a fifth ectopic gland in the mediastinum was resected. Biopsies were consistent with parathyroid carcinoma. Conclusion: Parathyroid carcinoma is an infrequent pathology in CKD, and should be considered in patients with sudden rises in calcium and/or PTH levels. Image studies are highly sensitive, but false negatives exist. Unsatisfactory decreases in intraoperative PTH levels suggest an ectopic gland, and may provide the key to a successful surgery.
doi:10.15406/emij.2016.03.00047 fatcat:dlv5qqltqraz3c5o4jiwffssae