Parathyroid Cancer and Hypercalcemic Crisis

Parathyroid cancer is an extremely rare endocrine malignancy as well as the least common cause of primary hyperparathyroidism. Patients can present with symptomatic hypercalcemia and occasionally, with a hypercalcemic crisis. Due to the increased risk for recurrence, a high index of suspicion pre-operatively is of the utmost importance. The mainstay of treatment is surgical, with an initial en-bloc resection of the parathyroid gland and surrounding tissue. These tumors are mostly refractory to chemotherapy and radiation and may require repeated surgical excisions for recurrence. A third of these tumors present with distant metastases at the time of diagnosis. Newer immunotherapies are focused on genetic targets such as parafibromin as well as cell-proliferation inhibitors. Parathyroid carcinoma has an indolent progression and mortality is usually related to adverse effects of hypercalcemia rather than metastatic disease burden.