Parathyroid carcinoma in a young woman with refractory hypercalcemia, lytic bone lesions, and a pulmonary nodule: a case report

Quispe-Ayma E.; Gamarra-Contreras M.; Ramírez-Vargas R.; Chumbiraico-Chumbimuni R.L.; Romero-Cuyo K. · Acta Medica Peruana (2026) · DOI: 10.35663/amp.2026.431.3968

Resumen

Parathyroid carcinoma (PC) is a rare endocrine neoplasm that is difficult to diagnose. We report the case of a twenty-eight-year-old woman with a prolonged clinical course characterized by pathological fractures secondary to severe hyperparathyroidism. She initially underwent parathyroid adenectomy without histological confirmation. She was readmitted for persistent hypercalcemia and markedly elevated parathyroid hormone (PTH) levels. Imaging studies revealed multifocal osteolytic lesions and an indeterminate pulmonary nodule. A total parathyroidectomy was performed, followed by total thyroidectomy because of an infiltrative lesion; parathyroid carcinoma was confirmed by histopathological examination. Due to persistent biochemical disease after surgery, residual cervical tissue was identified and prompted reoperation. Faced with refractory hypercalcemia, treatment with denosumab and zoledronic acid was initiated, resulting in progressive improvement of serum calcium levels. This case highlights the diagnostic and therapeutic challenges of parathyroid carcinoma in resource-limited settings and underscores the importance of a cautious approach when radiologic findings are suggestive but lack histological confirmation.

Instituciones: Universidad Nacional de San Antonio Abad del Cusco