The role of surgery in parathyroid disease has shown a recent decrease with development of calcinomimetics such as cinacalcet. During thyroid surgery, every endocrine surgeon makes every effort to preserve the parathyroid gland. However, postoperative hypoparathyroidism cannot be completely prevented. Knowledge of the precise anatomy of the parathyroid, including embryological movement of parathyroid glands, is needed. Surgical indications of parathyroidectomy include primary hyperparathyroidism, secondary hyperparathyroidism, tertiary hyperparathyroidism and parathyroid carcinoma. Parathyroidectomy for primary hyperparathyroidism has shown a significant change due to introduction of the sestamibi scan, intraoperative PTH assay, and focused parathyroidectomy. Minimally invasive surgery has now become standard operation for primary hyperparathyroidism. However, focused unilateral parathyroid operation should be done very cautiously because you can lose the chance of cure. Recurrence rate after parathyroidectomy is approximately 5% and experience of a surgeon can only reduce this rate. Surgery for secondary hyperparathyroidismis performed in only 1~2% of CKD patients. Surgical methods include subtotal parathyroidectomy, total parathyroidectomy, and total parathyroidectomy with autotransplantation and the results of the operation are not different. With the introduction of cinacalcet, comparison between surgery and medication showed an effective drop down of serum PTH level and increase of BMD only in surgery. Cincalcet did not show improvement of mortality, vascular calcification, and nephrplithiasis. According to oneJapanese report, PTH more than 500 pg/ml, size larger than 1 cm, and more than two enlarged parathyroid favor parathyroidectomy in renal osteodystrophy. During parathyroid surgery, high suspicion for carcinoma gives the only chance for cure because en bloc resection is important. Parathyroid disease has evolved since introduction of Cinacalcet and endocrine surgeons should join with physicians as a team for development of a treatment plan.
Autografts ; Cinacalcet Hydrochloride ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Hyperparathyroidism, Secondary ; Hypoparathyroidism ; Minimally Invasive Surgical Procedures ; Mortality ; Parathyroid Diseases ; Parathyroid Glands ; Parathyroid Neoplasms ; Parathyroidectomy ; Recurrence ; Renal Osteodystrophy ; Surgeons ; Thyroid Gland ; Transplantation, Autologous ; Vascular Calcification

Carcinoma of the parathyroid gland has been reported as a rare disease occurring in 0.5 to 4% of patients with the primary hyperparathyroidism. Brown tumor is characterized as the terminal stage of remodeling processes during the primary or secondary hyperparathyroidism. Brown tumor induced by the primary hyperparathyroidism can commonly occur in the ribs, clavicle, and pelvic bone. We experienced a case of a 29-year old female patient, who had parathyroid carcinoma leading to primary hyperparathyroidism, followed by multiple Brown tumor. We present this case of parathyroid carcinoma with Brown tumors with a brief review of literature.
Clavicle ; Female ; Humans ; Hyperparathyroidism, Primary ; Hyperparathyroidism, Secondary ; Osteitis Fibrosa Cystica ; Parathyroid Glands ; Parathyroid Neoplasms* ; Pelvic Bones ; Rare Diseases ; Ribs

Primary hyperparathyroidism is not a rare disease, but only several cases have been reported in Korean literature. Recently, we experienced one case of primary hyperparathyroidism with hypercalcemia, hypercalcemia, recurrent stone attacks and pathologic fracture. The patient underwent parathyroidectomy, which revealed parathyroid adenoma. The serum calcium, urinary calcium and parathyroid hormone levels were normalized postoperatively.
Calcium ; Fractures, Spontaneous ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary* ; Parathyroid Hormone ; Parathyroid Neoplasms ; Parathyroidectomy ; Rare Diseases ; Urolithiasis*

Primary Hyperparathyroidism is the metabolism abnormality of calcium, phosphate, and bone due to the high synthesis of parathyroid hormone, a rare endocrine disease in children. It scarcely occurs in children so that till now it was reported only 4 cases in Korea, especially with abdominal symptoms. We report this case of primary hyperparathyroidism with brief review of literatures.
Abdominal Pain ; Calcium ; Child ; Endocrine System Diseases ; Humans ; Hyperparathyroidism, Primary ; Korea ; Parathyroid Hormone ; Parathyroid Neoplasms

A parathyroid carcinoma is a rare cause of primary hyperparathyroidism. Even though the clinical presentation in a parathyroid carcinoma is usually symptomatic and different from that in benign parathyroid disease, a definite diagnosis can be made only by using a histologic examination of local invasion to surrounding tissue or metastases to regional lymph nodes or distant sites. It is important to confirm the malignancy at the initial operation because a radical resection offers the only possibility for cure. We experienced a 62-year-old woman with primary hyperparathyroidism caused by a parathyroid carcinoma, who had revealed the clinical manifestations of acute pancreatitis. A carcinoma in the right lower parathyroid was confirmed by histopathologic findings of invasion to the thyroid capsule. The patient was cured by using a radical resection of the parathyroidal mass, including the right lobe of the thyroid, the surrounding soft tissues, and the regional lymph nodes.
Diagnosis ; Female ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary* ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Pancreatitis ; Parathyroid Diseases ; Parathyroid Neoplasms* ; Thyroid Gland

Carcinoma of the parathyroid gland is rare, comprising only 0.1% to 5% of all patients with primary hyperparathyroidism. It presents with severe hypercalcemia, bone disease, palpable neck mass, renal involvement and etc. Since the initial operation offers the best chance for cure, preoperative localization and intraoperative recognition of parathyroid cancer are essential. Recently parathyroid imaging has been described with 99mTc-sestamibi as an alternative to 201Tl. This newer agent has many physical and dosirnetric advantages and represents higher detection sensitivity than 201Tl-99mTc subtraction scan. We experienced a 41-year-old man presenting with recurrent hyperparathyroidism in spite of 2 previous operations. In preoperative localization, there was no abnormal uptake in 201Tl-99mTc subtraction scan but 99mTc-sestamibi scan revealed metastatic foci on right cervical area. He was successfully treated with modified radical neck dissection.
Adult ; Bone Diseases ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Neck ; Neck Dissection ; Parathyroid Glands ; Parathyroid Neoplasms* ; Technetium Tc 99m Sestamibi*

Brown tumors also called as osteoclastomas, are rare nonneoplastic lesions that arise in the setting of primary or secondary hyperparathyroidism. Parathyroid adenomas or hyperplasia constitute the major Brown tumor source in primary hyperparathyroidism while chronic renal failure is the leading cause in secondary hyperparathyroidism. Most of the patients with the diagnosis of primary hyperparathyroidism present with kidney stones or isolated hypercalcemia. However, nearly one third of patients are asymptomatic and hypercalcemia is found incidentally. Skeletal involvement such as generalized osteopenia, bone resorption, bone cysts and Brown tumors are seen on the late phase of hyperparathyroidism. The symptoms include axial pain, radiculopathy, myelopathy and myeloradiculopathy according to their locations. Plasmocytoma, lymphoma, giant cell tumors and metastates should be ruled out in the differential diagnosis of Brown tumors. Treatment of Brown tumors involve both the management of hyperparathyroidism and neural decompression. The authors report a very rare spinal Brown tumor case, arisen as the initial manifestation of primary hyperparathyroidism that leads to acute paraparesis.
Bone Cysts ; Bone Diseases, Metabolic ; Bone Resorption ; Decompression ; Diagnosis ; Diagnosis, Differential ; Giant Cell Tumors ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary* ; Hyperparathyroidism, Secondary ; Hyperplasia ; Kidney Calculi ; Kidney Failure, Chronic ; Lymphoma ; Paraparesis ; Parathyroid Neoplasms ; Plasmacytoma ; Radiculopathy ; Spinal Cord Diseases ; Spine*

Parathyroid carcinoma is rare disease representing 1% to 4% of the cases of hyperparathyroidism. Coincidence of thyroid carcinoma in parathyroid adenoma is not uncommon, but synchronous parathyroid and thyroid carcinoma is extremely rare. As far as our investigation permits, there are only 4 cases reported in the literature of the world. Recently we experienced 2 cases of synchronous parathyroid carcinoma and papillary thyroid carcinoma. Both conditions developed in non-irradiated neck. The first case was preoperatively diagnosed as papillary carcinoma with nodal involvement, and the second, which presented the symptoms of hyperparathyroidism, was diagnosed as primary hyperparathyroidism combined with benign thyroid nodule preoperatively. Both cases, however, turned out to be coexisting parathyroid and papillary thyroid carcinomas. Surgeons should be aware of this condition when encountered with thyroid and parathyroid tumor in a patient.
Carcinoma, Papillary ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Neck ; Parathyroid Neoplasms ; Rare Diseases ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule

Parathyroid carcinoma is a rare disease in pediatric patients. We present a case of a 13-year-old girl who presented to the Thyroid Department for an asymptomatic palpable neck mass for 1 year. The high levels of calcium, ionized calcium, and parathyroid hormone level along with parathyroid scintigraphy studies suggested primary hyperparathyroidism. Parathyroid carcinoma was confirmed by biopsy and pathologic examination after resection. Six months postoperatively, persistent hypercalcemia and multiple lung metastases were found on computed tomography. Bilateral lung wedge resection was performed. En bloc resection for primary parathyroid carcinoma and aggressive resection of metastatic disease is the most effective treatment to control hypercalcemia.
Adolescent ; Biopsy ; Calcium ; Child ; Humans ; Hypercalcemia ; Hyperparathyroidism, Primary ; Lung ; Neck ; Neoplasm Metastasis ; Parathyroid Hormone ; Parathyroid Neoplasms ; Rare Diseases ; Thyroid Gland

Parathyroid carcinoma is very rare in patients with primary hyperparathyroidism, only accounts for 1% to 2% of all cases. It is characterized by higher incidence of renal dysfunction, metabolic bone disease and gastrointestinal symptoms. Although the clinical manifestations of hyperparathyroidism are more severe in patients with parathyroid carcinoma when compared to those with those with parathyroid adenoma, it is difficult to differentiate carcinoma from adenoma without pathologic confirmation. To our knowledge, there have only been a few cases of hyperparathyroidism due to parathyroid carcinomas reported to date. Here, we report a case of 63-year-old woman developing osteoporosis, hypercalcemia and hypophosphatemia due to a parathyroid tumor and was diagnosed with parathyroid carcinoma postoperatively.
Adenoma ; Bone Diseases, Metabolic ; Female ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Hypophosphatemia ; Incidence ; Middle Aged ; Osteoporosis ; Parathyroid Neoplasms