Parathyroid cancer as cause of fracture and secondary osteoporosis in the elderly adult
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Keywords

Parathyroid Neoplasms
Fractures
Bone
Osteoporosis
Postmenopausal
Hip Fractures
Thyroid Nodule
Primary Hyperparathyroidism

How to Cite

Huertas-Quintero, J. A. ., Camila Romero, M., Trejos, J. A. ., & Maldonado, L. M. . (2021). Parathyroid cancer as cause of fracture and secondary osteoporosis in the elderly adult. Revista Endocrino, 8(1). https://doi.org/10.53853/encr.8.1.693

Abstract

Background. Parathyroid carcinoma is a rare entity and it is even rarer in geriatric patients. It affects bone metabolism; it is often confused with common pathologies that cause low-impact fracture.

Objective. To illustrate parathyroid cancer in the study of pathological fractures and secondary osteoporosis, to favor early diagnosis in the elderly.

Case presentation. A 71-year-old woman with osteoporosis presented femur fracture while she was walking. Constitutional symptoms, anemia, nephrolithiasis, and osteolytic lesions were documented; presence of bone metastatic disease vs brown tumors were considered. Frequent gynecological neoplasms and plasma cell tumors were ruled out. Tomographic studies showed pulmonary nodule and thyroid nodule (4cm), evaluation of phospho-calcium metabolism indicated primary hyperparathyroidism, Tc-99m MIBI parathyroid scintigraphy was negative. After receiving zoledronate, the patient underwent exploratory surgery, left thyroidectomy with its parathyroid in bloc and right upper parathyroidectomy. Histopathology and immunohistochemistry of neck mass reported parathyroid carcinoma. Post-surgical follow-up showed higher PTH elevation and hypercalcemia, and follow-up images showed multiple lung metastasis.

Discussion and conclusion. Osteoporotic fractures are frequent, however, when there is presence of atypical fractures and/or a Z-score ?-2, tumoral and infectious causes, as well as the early evaluation of phospho-calcium metabolism must be considered. Parathyroid carcinoma is more frequent around age fifty. However, it can occur at any age. In the elderly, it shares clinical characteristics with prevalent etiologies such as postmenopausal osteoporosis, nephrolithiasis, and thyroid nodule. Parathyroid cancer has a broad clinical spectrum and should be a diagnostic possibility in atypical fractures, and severe hyperparathyroidism, even in the absence of parathyroid lesion in a 99m-MIBI-SPECT or in the presence of thyroid disease. Early surgical approach is the best therapeutic option. Histological diagnosis must be supported on immunohistochemistry due to a lack of specific cytologic features in parathyroid cancer.

https://doi.org/10.53853/encr.8.1.693
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