Parathyroid Carcinoma Guidelines

Updated: Aug 03, 2021
  • Author: Lawrence T Kim, MD, FACS, FACE; Chief Editor: Neetu Radhakrishnan, MD  more...
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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