Resistant hypercalcaemia in metastatic parathyroid carcinoma

Bowyer, Samantha; White, Alison M.; Ransom, David; Davidson, John

doi:10.5694/mja12.11243

Cited by 23 publications

(37 citation statements)

References 12 publications

(18 reference statements)

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“…It has been shown to have a profound effect in modulating malignant hypercalcaemia (6). Very recently, the use of denosumab in the treatment of hypercalcaemia related to parathyroid carcinoma has been reported in two case reports (7,8). We were contemporaneously using denosumab for a similar patient with hypercalcaemia and parathyroid carcinoma and report its high efficacy when all else had failed.…”

Section: Introductionmentioning

confidence: 99%

Refractory hypercalcaemia secondary to parathyroid carcinoma: response to high-dose denosumab

Karuppiah

Thanabalasingham

Shine

et al. 2014

European Journal of Endocrinology

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Objective: Hypercalcaemia is an important cause of increased morbidity and mortality in patients with parathyroid carcinoma. Surgical resection is the mainstay of treatment but, equally, managing hypercalcaemia is of paramount importance. At present, few therapies have been shown to be effective in the most severe cases. This report describes the efficacy of denosumab in a patient with parathyroid carcinoma when conventional therapies had been shown to be relatively ineffective. Subject, methods and results: A 50-year-old man presented with symptomatic hypercalcaemia 1 year after the surgery for his parathyroid carcinoma. Investigations revealed raised serum calcium and parathyroid hormone concentrations consistent with the recurrence of the disease. Imaging failed to localise any surgically remediable foci. Medical management with loop diuretics, calcimimetics and bisphosphonates failed to provide a sustained response. Denosumab, as a monthly injection, led to a gradual decrement in his peak calcium concentrations with the values now persistently below 3 mmol/l. Conclusions: Denosumab, a fully human MAB that binds to the 'receptor activator of nuclear factor kB ligand (RANKL)', was shown to have a profound effect in modulating malignant hypercalcaemia. This medication should be considered as an effective option in patients with refractory hypercalcaemia secondary to parathyroid carcinoma.

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Section: Introductionmentioning

confidence: 99%

Refractory hypercalcaemia secondary to parathyroid carcinoma: response to high-dose denosumab

Karuppiah

Thanabalasingham

Shine

et al. 2014

European Journal of Endocrinology

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“…The prevalence of PC is estimated to be less than 1% of cases of primary hyperparathyroidism, and incidence from 3.5 to 5.73 per 10 million has been reported [3][4][5][6]. However, in Japan and in Italy this cancer is more prevalent compared to other Western countries, concerning about 5% of subjects with hyperparathyroidism [9,16,17].…”

Section: Epidemiology Of Parathyroid Carcinomamentioning

confidence: 99%

“…Parathyroid malignancy is usually associated with a high rate of local and distant recurrence, despite curative resection, and most of patients require re-operation [3,4,25,36]. Persistent hypercalcaemia and progressive increase in PTH levels are often the first signs of recurrence [1,18].…”

Section: The Natural Course Of Parathyroid Carcinomamentioning

confidence: 99%

“…Double (multi-glandular) parathyroid carcinoma is rare [12]. The histological features of PC may initially be also non-specific [3,4]. Moreover, parathyroid gland could be located in ectopic sites such as the mediastinum, the base of the skull, and within the thyroid gland, and when it occurs the diagnostic difficulty increases significantly [2,13].…”

Section: Introductionmentioning

confidence: 99%

“…It is a rare endocrine malignancy [3][4][5][6], which originates in the parenchymatous cells of the parathyroid glands [1]. Most parathyroid cancers secrete PTH and cause hypercalcaemia in the course of primary hyperparathyroidism [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Pierwotna nadczynność przytarczyc w przebiegu raka przytarczyc — wyzwanie diagnostyczne i terapeutyczne

Dabrowska

Tarach

Zwolak

2015

Endokrynologia Polska

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Parathyroid carcinoma (PC) is a rare endocrine malignancy and the cause of primary hyperparathyroidism. It is usually associated with a high rate of local and distant recurrence. Laboratory findings and clinical symptoms may be similar to those in parathyroid adenoma. The histological features of PC may also be non-specific and the affected gland is often indistinguishable from a benign lesion. The proper diagnosis is commonly made months to years later when the disease recurs or metastases are present. Therefore, parathyroid carcinoma still remains a diagnostic and management challenge for many physicians. However, there are some features that, in combination, may help in diagnosis. Surgery still remains the only curative treatment, even in metastatic disease. In advanced, non-operable subjects, managing hypercalcaemia and controlling a tumour are the main goals. Morbidity is caused by hypercalcaemia rather than metastases. A multidisciplinary approach with experienced endocrinologists, pathologists, radiologists, nuclear medicine doctors, oncologists, and surgeons is needed to optimize patient outcome. StreszczenieRak przytarczyc (PC) jest rzadkim nowotworem złośliwym układu wewnątrzwydzielniczego, a także rzadką przyczyną pierwotnej nadczynności przytarczyc. Zazwyczaj wiąże się z wysokim odsetkiem miejscowych i odległych przerzutów. Wyniki badań laboratoryjnych i objawy kliniczne mogą przypominać te spotykane w przebiegu gruczolaków przytarczyc. Równie niespecyficzny jest obraz histopatologiczny raka przytarczyc, co powoduje trudności w diagnostyce różnicowej ze zmianami łagodnymi, będącymi gruczolakami. Właściwe rozpoznanie często jest stawiane z kilkumiesięcznym lub kilkuletnim opóźnieniem, w oparciu o nawrót choroby lub pojawiające się przerzuty. Mając na uwadze ten fakt, rak przytarczyc ciągle pozostaje wyzwaniem diagnostycznym i terapeutycznym dla wielu specjalistów. Jakkolwiek, wyróżnia się jednak pewne objawy, których obecność może pomóc w postawieniu właściwej diagnozy. Leczenie chirurgiczne pozostaje nadal jedyną skuteczną opcją terapeutyczną, nawet w sytuacji pojawienia się zmian przerzutowych. W zaawansowanych, nieoperacyjnych przypadkach głównym celem leczenia pozostaje obniżanie stężenia wapnia we krwi i kontrola wielkości guza. Śmiertelność związana z rakiem przytarczyc wynika raczej z hiperkalcemii, niż obecności przerzutów. W celu poprawy wyników leczenia, niezbędne jest podejście wielodyscyplinarne oraz współdziałanie wielu doświadczonych specjalistów: endokrynologów, patologów, radiologów, medyków nuklearnych, onkologów i chirurgów.

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Parathyroid Carcinoma

Cetani

Marcocci

2015

The Parathyroids

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Resistant hypercalcaemia in metastatic parathyroid carcinoma

Cited by 23 publications

References 12 publications

Refractory hypercalcaemia secondary to parathyroid carcinoma: response to high-dose denosumab

Refractory hypercalcaemia secondary to parathyroid carcinoma: response to high-dose denosumab

Pierwotna nadczynność przytarczyc w przebiegu raka przytarczyc — wyzwanie diagnostyczne i terapeutyczne

Parathyroid Carcinoma

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