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Abstract：
BACKGROUND: Parathyroid carcinoma (PC) is a rare endocrine malignancy causing pathological changes such as abnormal bone metabolism, elevated serum calcium, and impaired renal function, and uncontrollable hypercalcemia is the main cause of death in PC patients. The diagnosis of PC is challenging and relying on postoperative histopathology. Radical surgery at the first time is the only effective therapy to cure PC. Hungry bone syndrome (HBS) is a relatively uncommon complication of parathyroidectomy characterized by profound and prolonged hypocalcemia, timely electrolyte monitoring and alternative interventional protocols can prevent symptomatic hypocalcemia.
METHODS: A 57-year-old man presented with multiple pathological fractures and muscle atrophy as the main symptoms accompanied by bone pain, hypercalcemia, elevated parathyroid hormone (PTH), and an enlarged left-sided neck mass. After consultation of multidisciplinary team, he was treated conservatively with plaster bandage fixation and infusion of intravenous zoledronic acid; and then complete resection of parathyroid mass + removal of involved tissue structures + left thyroid and isthmus lobectomy + lymph node dissection in the VI region in left neck were performed. The postoperative histopathology suggested a diagnosis of parathyroid carcinoma. Calcium and fluid supplementation and oral levothyroxine tablets were given postoperatively. Unexpectedly, the patient\'s PTH level decreased rapidly at 24 h postoperative, and serum calcium and phosphorus decreased continuously, and he felt numb around perioral sites and fingertips, which considered to be postoperative HBS complicated by parathyroidectomy. Then, a large amount of calcium supplementation and vitamin D were given timely and the patient got better at 1 month postoperatively. At 9-month postoperative, his bone pain and fatigue were significantly relieved compared with before with calcium, phosphorus, and PTH levels at normal range.
CONCLUSIONS: The possibility of parathyroid disease, particularly PC, should be considered in the presence of multiple pathological fractures, muscle atrophy, generalized bone pain, hypercalcemia, and clear neck mass. Radical resection of the tumor lesions at the first surgery is a key element affecting the prognosis of PC, and the effective management of preoperative hypercalcemia and postoperative HBS is also of great significance for improving prognosis.
METHODS: A 57-year-old man presented with multiple pathological fractures and muscle atrophy as the main symptoms accompanied by bone pain, hypercalcemia, elevated parathyroid hormone (PTH), and an enlarged left-sided neck mass. After consultation of multidisciplinary team, he was treated conservatively with plaster bandage fixation and infusion of intravenous zoledronic acid; and then complete resection of parathyroid mass + removal of involved tissue structures + left thyroid and isthmus lobectomy + lymph node dissection in the VI region in left neck were performed. The postoperative histopathology suggested a diagnosis of parathyroid carcinoma. Calcium and fluid supplementation and oral levothyroxine tablets were given postoperatively. Unexpectedly, the patient\'s PTH level decreased rapidly at 24 h postoperative, and serum calcium and phosphorus decreased continuously, and he felt numb around perioral sites and fingertips, which considered to be postoperative HBS complicated by parathyroidectomy. Then, a large amount of calcium supplementation and vitamin D were given timely and the patient got better at 1 month postoperatively. At 9-month postoperative, his bone pain and fatigue were significantly relieved compared with before with calcium, phosphorus, and PTH levels at normal range.
CONCLUSIONS: The possibility of parathyroid disease, particularly PC, should be considered in the presence of multiple pathological fractures, muscle atrophy, generalized bone pain, hypercalcemia, and clear neck mass. Radical resection of the tumor lesions at the first surgery is a key element affecting the prognosis of PC, and the effective management of preoperative hypercalcemia and postoperative HBS is also of great significance for improving prognosis.
摘要：
背景：甲状旁腺癌（PC）是一种罕见的内分泌恶性肿瘤，可引起骨代谢异常等病理改变，血清钙升高，肾功能受损，无法控制的高钙血症是PC患者死亡的主要原因。PC的诊断具有挑战性，并且依赖于术后组织病理学。首次进行根治性手术是治愈PC的唯一有效疗法。饥饿骨综合征（HBS）是甲状旁腺切除术的一种相对罕见的并发症，其特征是严重和长期的低钙血症。及时的电解质监测和替代介入方案可以预防症状性低钙血症.
方法：一名57岁男子，以多发病理性骨折和肌肉萎缩为主要症状，并伴有骨痛，高钙血症,甲状旁腺激素（PTH）升高，左侧颈部肿块增大.经过多学科小组的协商，给予石膏绷带固定和静脉输注唑来膦酸保守治疗；然后进行甲状旁腺肿块完全切除+累及组织结构切除+左甲状腺和峡部肺叶切除+左颈VI区淋巴结清扫。术后组织病理学提示诊断为甲状旁腺癌。术后给予钙和液体补充以及口服左甲状腺素片。出乎意料的是,患者的PTH水平在术后24小时迅速下降，血清钙和磷持续下降，他感到口周部位和指尖麻木，这被认为是术后HBS并发甲状旁腺切除术。然后，及时补充大量钙和维生素D，患者在术后1个月好转。术后9个月,与服用钙剂前相比，他的骨痛和疲劳明显缓解，磷，和PTH水平在正常范围内。
结论：甲状旁腺疾病的可能性，尤其是PC,应该考虑在存在多种病理性骨折的情况下，肌肉萎缩,全身骨痛,高钙血症,和清晰的颈部质量。首次手术切除肿瘤病灶是影响PC预后的关键因素,术前高钙血症和术后HBS的有效治疗对改善预后也有重要意义。
方法：一名57岁男子，以多发病理性骨折和肌肉萎缩为主要症状，并伴有骨痛，高钙血症,甲状旁腺激素（PTH）升高，左侧颈部肿块增大.经过多学科小组的协商，给予石膏绷带固定和静脉输注唑来膦酸保守治疗；然后进行甲状旁腺肿块完全切除+累及组织结构切除+左甲状腺和峡部肺叶切除+左颈VI区淋巴结清扫。术后组织病理学提示诊断为甲状旁腺癌。术后给予钙和液体补充以及口服左甲状腺素片。出乎意料的是,患者的PTH水平在术后24小时迅速下降，血清钙和磷持续下降，他感到口周部位和指尖麻木，这被认为是术后HBS并发甲状旁腺切除术。然后，及时补充大量钙和维生素D，患者在术后1个月好转。术后9个月,与服用钙剂前相比，他的骨痛和疲劳明显缓解，磷，和PTH水平在正常范围内。
结论：甲状旁腺疾病的可能性，尤其是PC,应该考虑在存在多种病理性骨折的情况下，肌肉萎缩,全身骨痛,高钙血症,和清晰的颈部质量。首次手术切除肿瘤病灶是影响PC预后的关键因素,术前高钙血症和术后HBS的有效治疗对改善预后也有重要意义。
