DIFFICULTIES IN THE MANAGEMENT OF A PARATHYROID CARCINOMA - CASE-REPORT

The case of a parathyroid carcinoma in a 61-year-old woman is describe d. The patient was referred to our hospital, with the diagnosis of med ullary thyroid carcinoma, after a prior thyroidectomy performed at ano ther hospital. On admission, serum calcium was 3.92 mmol/l (n.r. 2.2-2 .5), PTH level was 320 ng/l (n.r. 10-65), urinary cAMP was 508.9 mmol/ mmol creatinine (n.r. 330- 630) and serum calcitonin was 2.1 ng/l (n.r .<10). The patient was then submitted to a complete neck exploration a nd multiple nodules were removed. Histopathological diagnosis of parat hyroid carcinoma was made by local recurrence and retrospectively upon closer examination of the original specimen. After surgery, normocalc emia was achieved and maintained for about four months. Serum PTH decr eased to 28.8 ng/l after surgery but increased quickly to 75.6 ng/l te n days later. Three months later, there was both biochemical and clini cal evidence of disease. In the following eight months, calcium levels ranged from 2.99 mmol/l to 4-24 mmol/l and PTH from 135 ng/l to 1431 ng/l. However no distant metastases were found. To Control hypercalcem ia, the patient was treated with bisphosphonates but normocalcemia was never achieved. A slight and transient reduction in serum calcium as response to an acute administration of octreotide, made us not to cons ider this eventual modality of therapy. Sonographically guided percuta neous injection of ethanol was performed but the treatment was not fou nd to be effective. Finally, the use of chemotherapy with 5-fluorourac il, cyclophosphamide and dacarbazine was also unsuccessful. The patien t died two years after the initial diagnosis.