A Challenging Case of Parathyroid Carcinoma in an Adolescent
https://doi.org/10.15605/jafes.041.S1
- Author:
S. Muhammad Imran
1
;
Tong Chin Voon
1
Author Information
1. Hospital Putrajaya
- Publication Type:Journal Article
- MeSH:
Adolescent;
Humans;
Parathyroid Neoplasms
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):73-74
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Parathyroid carcinoma (PC) is an exceedingly rare
malignancy. Definitive surgical management with en bloc
resection is crucial for cure, but the post-operative course
can be complicated by profound metabolic derangements,
most notably hungry bone syndrome (HBS). We report
a case of PC in a 15-year-old female to highlight the
challenges in perioperative management.
Case:A 15-year-old female presented with a painless, palpable
neck mass. There is no family history of note. Investigations
revealed severe primary hyperparathyroidism (PHPT)
with a corrected calcium of 3.4 mmol/L and an elevated
intact parathyroid hormone level of 118.6 pg/mL. Alkaline
phosphatase was markedly elevated at 1,168 U/L.
Ultrasound, computed tomography neck, and a sestamibi
scan identified a large, lobulated 4.7-cm mass posterior
to the right thyroid lobe, suspicious of malignancy. Bone
mineral density of the forearm was severely diminished,
with a Z-score of -6.6. The patient underwent right
hemithyroidectomy and parathyroidectomy with intraoperative neural monitoring. Intraoperative parathyroid
hormone levels dropped from a pre-excision level of
120.1–16.5 pg/mL 5 minutes post-excision, confirming
complete resection of the hyperfunctioning tissue. Histopathological examination confirmed the diagnosis of
PC, demonstrating lymphovascular invasion and clear
resection margins. The Ki-67 proliferation index was 5%.
Post-operatively, the patient developed hypocalcemia,
with corrected calcium dropping to a nadir of 1.95 mmol/L.
This was managed with intensive calcium and activated
vitamin D supplementation. At 10 months post-surgery,
the patient continues to require supplementation for
persistent hypocalcemia. Surveillance ultrasound at 3
months showed no evidence of recurrence, and she is
planned for ongoing annual monitoring.
Conclusion:This case illustrates the need for a high index of suspicion
for PC in young patients with severe PHPT. The postoperative course highlights the challenges in managing
HBS, hypoparathyroidism, and long-term surveillance.
- Full text:2026080410504022875EP_A098.pdf
