Parathyroid Cancer: Early Warning Signs of Hypercalcemia and Confirmation Methods for Elevated PTH Levels

The parathyroid cancer is an extremely rare endocrine neoplasm, representing less than 1% of all cases of primary hyperparathyroidism. Despite its rarity, its diagnosis and management present significant challenges due to the lack of clear distinctive features and its similarity to benign parathyroid diseases. Severe hypercalcemia is often the first warning sign, and its management is crucial to improve the patient's quality of life and reduce associated mortality.

Hypercalcemia as an Early Warning Sign

Hypercalcemia is the most characteristic biochemical sign of parathyroid cancer, and it is usually more pronounced than in other forms of hyperparathyroidism. Patients may present symptoms such as fatigue, muscle weakness, bone pain, and gastrointestinal symptoms. In advanced cases, hypercalcemia can be uncontrollable and pose a life-threatening risk to the patient. Recent studies have highlighted the importance of early detection of hypercalcemia for the timely diagnosis of parathyroid cancer [1](https://ascpt.onlinelibrary.wiley.com/doi/10.1002/cpt.3432).

The differential diagnosis between parathyroid cancer and other causes of hyperparathyroidism is complex. Measuring elevated PTH levels is essential, as these are often significantly increased in parathyroid cancer, frequently exceeding three to ten times the upper normal limit [2](https://erc.bioscientifica.com/view/journals/erc/30/4/ERC-22-0287.xml).

Confirmation Methods

The definitive diagnosis of parathyroid cancer is based on identifying specific histopathological features, such as vascular or perineural invasion and invasion into adjacent structures. Parathyroid scintigraphy and other advanced imaging techniques can assist in locating the tumor and assessing its extent [3](https://linkinghub.elsevier.com/retrieve/pii/S0093775410001831).

The primary treatment is en bloc surgical resection of the tumor, which offers the best chance for a cure. However, in cases of unresectable disease, emerging systemic therapies, such as the use of tyrosine kinase inhibitors and temozolomide, have been explored, although their efficacy is still under evaluation [4](https://www.turkjpath.org/text.php?doi=10.5146/tjpath.2015.01316).

Conclusions

Parathyroid cancer remains a diagnostic and therapeutic challenge due to its rarity and nonspecific clinical presentation. Severe hypercalcemia and elevated PTH levels are key indicators that should alert clinicians to the possibility of this disease. Early detection and multidisciplinary management in specialized centers are essential to improve outcomes for these patients. Ongoing research into the molecular and genetic bases of parathyroid cancer promises to open new avenues for diagnosis and treatment in the future [5](https://linkinghub.elsevier.com/retrieve/pii/S0303720724001850).

Referencias

• [1] Diagnosis and Management of Parathyroid Carcinoma
• [2] Diagnosis and management of parathyroid carcinoma: a state-of-the-art review
• [3] Parathyroid cancer
• [4] Parathyroid Carcinoma: Diagnosis and Clinical Implications
• [5] Advances in the management of parathyroid carcinoma

Created 13/1/2025