Bone resorption in parathyroid carcinoma.

To cite: Naderi N, McCurdy MT, Reed RM. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013203396 DESCRIPTION A man in his 30s with a history of end-stage renal disease (ESRD) and metastatic parathyroid carcinoma presented to the hospital with severe shortness of breath, hypercalcaemia and diffuse bone pain. Chest radiograph (figure 1A) demonstrated profound demineralisation, and the distal phalanges appeared abnormal (figure 1B) due to bony resorption characteristic of severe hyperparathyroidism. Parathyroid carcinomas are an exceeding rare cause of hyperparathyroidism. It is important to distinguish between benign parathyroid adenomas and parathyroid malignancies, since the latter carries a very high mortality and the only successful treatment is surgical resection. 2 As with this patient, those with parathyroid carcinomas, unlike their counterparts with benign adenomas, tend to be younger, have ESRD or some degree of renal insufficiency, have severe hypercalcaemia (>15 mg/ dL) and present with intense symptoms. Radiological findings such as osteitis fibrosa cystica (figure 1A) are far more common in parathyroid carcinomas (44–91%) compared with benign parathyroid adenomas (5%) due to the degree of parathyroid hormone elevation and bone resorption seen in the former.