Guidelines Summary

The 2016 American Association of Endocrine Surgeons (AAES) guidelines for definitive management of primary hyperparathyroidism (pHPT) include the following recommendations for diagnosis and treatment of parathyroid carcinoma^[43]:

The diagnosis of parathyroid carcinoma should be considered in patients with pHPT, markedly elevated PTH levels and severe hypercalcemia
Patients with pHPT who present with hypercalcemic crisis should be medically managed, followed by parathyroidectomy for suspected parathyroid carcinoma
If parathyroid carcinoma is suspected, patients should be treated surgically because this is the only potentially curative treatment
Parathyroidectomy is indicated when the clinical or biochemical evidence is consistent with parathyroid carcinoma
Preoperative parathyroid fine-needle aspiration biopsy is not recommended
Histologic diagnosis relies on identification of unequivocal angioinvasion and can be assisted by biomarkers
When there is intraoperative suspicion of parathyroid carcinoma, complete resection avoiding capsular disruption offers potential cure; en bloc resection of adherent tissues may be required
There is insufficient evidence to recommend prophylactic central or lateral neck dissection
Adjuvant external beam radiotherapy is reserved for palliative care and should not be routinely performed after surgical resection

Medication

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Media Gallery

Photomicrograph of parathyroid carcinoma showing typical fibrotic septae. Histologic diagnosis can be difficult.

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Author

Lawrence T Kim, MD, FACS, FACE Professor, Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, University of North Carolina at Chapel Hill School of Medicine; Member, UNC Lineberger Comprehensive Cancer Center

Lawrence T Kim, MD, FACS, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists, American Association of Endocrine Surgeons, American College of Endocrinology, American College of Surgeons, American Thyroid Association, International Association of Endocrine Surgeons, Parkland Surgical Society, Society of Surgical Oncology, Southern Surgical Association, Surgical Discovery Club

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Neetu Radhakrishnan, MD Medical Oncologist, Kettering Cancer Care

Neetu Radhakrishnan, MD is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, American Society of Hematology

Disclosure: Nothing to disclose.

Additional Contributors

Sanjiv S Agarwala, MD Chief of Oncology and Hematology, St Luke's Cancer Center, St Luke's Hospital and Health Network; Professor, Temple University Shool of Medicine

Sanjiv S Agarwala, MD is a member of the following medical societies: American Association for Cancer Research, American Head and Neck Society, European Society for Medical Oncology, American Society of Clinical Oncology, Eastern Cooperative Oncology Group

Disclosure: Received honoraria from BMS for speaking and teaching; Received consulting fee from Novartis for consulting; Received consulting fee from Merck for consulting.

Acknowledgements

Wendy Hu, MD Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center

Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.