A case of parathyroid carcinoma with hypercalcemia responsive to cinacalcet therapy.
BACKGROUND
A 54-year-old man presented to the emergency department of his local hospital with a 1-year history of fatigue, weight loss, and constipation. He had abused alcohol for many years, and his symptoms were initially attributed to alcoholism. On physical examination, he was confused, his blood pressure was normal, he had no palpable neck masses, and his liver was enlarged. His serum calcium concentration was 4.2 mmol/l and his serum parathyroid hormone concentration was 36 pmol/l. CT-guided biopsy of a liver lesion showed large neoplastic cells, and fine-needle aspiration of the neck showed cells similar to those in the liver. The patient was treated with intravenous saline, pamidronate, and zoledronic acid. He was referred to our hospital on day 35 for treatment of refractory hypercalcemia.


METHODS
Sestamibi parathyroid scan, chest and abdominal CT scans, neck ultrasonography, liver biopsy, fine-needle aspiration of neck mass, and measurement of parathyroid hormone in an aspirate of the neck mass.


METHODS
Primary hyperparathyroidism caused by metastatic parathyroid carcinoma.


RESULTS
Intravenous fluids, intravenous doses of pamidronate and zoledronic acid and oral cinacalcet therapy.
Szmuilowicz
Emily D
ED
Brigham and Women's Hospital, Boston, MA, USA.
Utiger
Robert D
RD
D000230:Adenocarcinoma / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D000428:Alcohol Drinking / Q000009:adverse effects; D044963:Biopsy, Fine-Needle; D002117:Calcitriol / Q000097:blood; D002118:Calcium / Q000097:blood; D000069449:Cinacalcet; D006801:Humans; D006934:Hypercalcemia / Q000150:complications / Q000188:drug therapy*; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis / Q000209:etiology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000627:therapeutic use*; D009333:Neck / Q000000981:diagnostic imaging; D009362:Neoplasm Metastasis / Q000175:diagnosis / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000556:secondary; D011859:Radiography; D014463:Ultrasonography
D009281:Naphthalenes; D010281:Parathyroid Hormone; D002117:Calcitriol; D002118:Calcium; D000069449:Cinacalcet