Parathyroid carcinoma is a very rare malignant tumor of the parathyroid gland. Clinically, this cancer is characterized by the presence of severe primary hyperparathyroidism. Diagnosis is based on histological examination but is not always easy. Surgery is the treatment of choice. We report the case of a year old woman with a personal history of arterial hypertension and of recurrent renal lithiasis, presenting with diffuse bone pain associated with asthenia. Neck examination showed hard basi-cervical swelling with nonpalpable lower edge.
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La chirurgie est le seul traitement curatif. The diagnosis is ordinarily easily made, based on an inappropriately elevated parathormone level PTH in the face of an elevated serum calcium level. Other investigations are reserved for persistent or recurrent HPT1 post surgery. Surgery is the only cure. The surgical approach may include a bilateral cervical exploration, a unilateral approach under local anesthesia, or focused minimally invasive video-assisted or totally endoscopic approaches.
Surgery is recommended even for moderate HPT1 and for very elderly patients because improvement in both the quality of life and bone density have been proven in these situations.
The role of medical treatment is limited. Persistent or recurrent HPT1 requires a meticulous diagnostic approach and management in surgical centers with expertise.
Persistent elevation of PTH postoperatively without hypercalcemia does not mandate further exploration. The outcome of normocalcemic patients with elevated postoperative PTH levels remains uncertain. Durand, H. Daligand, P. Aubert, B. Journal page Archives Contents list.
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Reflexions sur 113 interventions pour hyperparathyroidie primaire.