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Resistant hypercalcaemia in metastatic parathyroid carcinoma

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We report a case of inoperable metastatic parathyroid carcinoma involving life-threatening hypercalcaemia that failed to respond to standard therapy. Our review of available therapeutic modalities showed a paucity of evidence to guide management of patients with these rare tumours. This is the first report of the treatment of malignant hypercalcaemia secondary to parathyroid carcinoma using denosumab.

Clinical record

A 45-year-old man with no significant past medical history presented with a fractured clavicle and evidence of a radiolucent lesion (brown tumour) within the clavicle on x-ray, characteristic for hyperparathyroidism (Box 1). On further investigation, biochemical analysis showing raised serum calcium and parathyroid hormone (PTH) levels confirmed primary hyperparathyroidism. A thyroid ultrasound showed a 39 × 29 × 32 mm mass in the right lobe, suggestive of a tumour. A staging computed tomography (CT) scan of the neck and chest and a bone scan showed bone changes consistent with hyperparathyroidism throughout the axial and appendicular skeleton. There was no evidence of metastatic disease.

The patient underwent a partial parathyroidectomy and right hemithyroidectomy. Histopathological examination…