Palabras clave
carcinoma de paratiroides
malignidad
hiperparatiroidismo primario
diagnóstico
tratamiento
Cómo citar
Resumen
Contexto: el carcinoma de paratiroides es una neoplasia endocrina infrecuente. Su presentación clínica es consecuencia de la hipercalcemia asociada, usualmente de difícil manejo y con alta probabilidad de recurrencia a pesar del manejo quirúrgico.
Objetivo: revisar la evidencia más reciente sobre el diagnóstico y tratamiento del carcinoma de paratiroides.
Metodología: se realizó una revisión en la base de datos PubMed de los estudios sobre diagnóstico y tratamiento del carcinoma de paratiroides publicados en inglés y español, en los últimos 20 años hasta octubre del 2024.
Resultados: existen predictores clínicos de carcinoma de paratiroides, sin embargo, el diagnóstico sigue siendo histopatológico en la muestra quirúrgica completa. El manejo quirúrgico constituye la base del tratamiento, la resección en bloque ha demostrado reducir el riesgo de recurrencia comparado con la resección solamente, sin un impacto en la supervivencia. Ante la alta probabilidad de recurrencia y persistencia de la enfermedad, las terapias farmacológicas son usualmente requeridas para el manejo de la hipercalcemia, logrando un control, con frecuencia temporal, en las concentraciones de calcio. En casos de hipercalcemia persistente a pesar del manejo médico y progresión de la enfermedad, las terapias sistémicas como los inhibidores de tirosina quinasa pueden conseguir una respuesta rápida, sin embargo, la evidencia aún es limitada.
Conclusiones: el diagnóstico del carcinoma de paratiroides requiere de una confirmación histológica, esto hace que, en algunos casos, el manejo primario no sea una cirugía en bloque. El manejo farmacológico contribuye al control de la hipercalcemia, pero en pacientes con enfermedad progresiva se debe considerar una terapia antineoplásica sistémica.
Citas
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