Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.
Institute of Primary Health Care, University of Bern, Bern, Switzerland.
Front Endocrinol (Lausanne). 2022 Jan 31;12:794988. doi: 10.3389/fendo.2021.794988. eCollection 2021.
Refractory hypercalcemia is one of the major complications of parathyroid carcinoma.
An 84-year old female patient presented with an acute confusional state due to hypercalcemia. This led to the diagnosis of primary hyperparathyroidism for which she underwent surgery. The initial histological diagnosis was interpreted as atypical parathyroid adenoma; the resection was microscopically incomplete. One year later, the patient presented with elevated calcium levels up to 3.89 mmol/l. Recurrent severe hypercalcemia required multiple hospitalizations. Review of the histology slides revealed that the initially resected lesion was in fact a parathyroid carcinoma. Treatment with the calcimimetic drug cinacalcet was poorly tolerated. Repeated administration of zoledronic acid only had transient effects on calcium levels, and bisphosphonate treatment was ultimately discontinued because of chronic renal failure. The patient then received denosumab (60 or 120 mg) when needed (nine doses over twenty months), the last dose in November 2020, which led to a reduction and control of here calcium levels. Currently, at three years after initial surgery, calcium levels are stable between 2.7-2.8 mmol/l and the patient has not required hospitalization for hypercalcemia for 10 months.
In case of parathyroid carcinoma, resection is the first treatment. Denosumab has proven its efficiency in treating hypercalcemia in malignancy. Several case reports studied denosumab in hypercalcemia due to parathyroid carcinoma, and the treatment were efficient to decrease levels of calcium when repeated as needed or monthly. We report another case of refractory hypercalcemia treated with several doses of denosumab in a patient with parathyroid carcinoma.
甲状旁腺癌的主要并发症之一是难治性高钙血症。
一名 84 岁女性患者因高钙血症出现意识障碍，导致原发性甲状旁腺功能亢进，行手术治疗。最初的组织学诊断为甲状旁腺腺瘤不典型；显微镜下切除不完全。一年后，患者出现钙水平升高至 3.89mmol/L。复发性严重高钙血症需要多次住院治疗。对组织学切片的回顾显示，最初切除的病变实际上是甲状旁腺癌。使用钙敏感受体激动剂西那卡塞治疗效果不佳。反复给予唑来膦酸仅对钙水平有短暂影响，且由于慢性肾衰竭，双膦酸盐治疗最终停止。然后，患者在需要时（20 个月内使用了九剂）接受地舒单抗（60 或 120mg）治疗，最后一剂是在 2020 年 11 月，这导致钙水平降低和控制。目前，在初次手术后三年，钙水平稳定在 2.7-2.8mmol/L 之间，患者 10 个月来没有因高钙血症住院。
在甲状旁腺癌的情况下，切除是首选治疗方法。地舒单抗已被证明在治疗恶性肿瘤相关高钙血症方面有效。有几个病例报告研究了地舒单抗在甲状旁腺癌引起的高钙血症中的应用，当需要时或每月重复使用，该治疗可有效降低钙水平。我们报告了另一个甲状旁腺癌难治性高钙血症患者，使用了几剂地舒单抗治疗。
