How can parathyroid cancer be recognized?
Parathyroid cancer is the rarest of all endocrine tumors, with a reported incidence of < 1% in patients with primary HPT. It is difficult to distinguish parathyroid cancer from the more common benign causes of HPT, and the diagnosis is frequently not suspected preoperatively. Parathyroid cancer should be suspected preoperatively when patients present with rapid-onset, severe, symptomatic hypercalcemia (> 14 mg/dL), very high PTH levels (> 5 times normal), a palpable neck mass, or hoarseness. It should be suspected intraoperatively when the tumor is large, firm, fibrotic, or invasive to the thyroid or other surrounding structures. Successful outcome requires early recognition and complete resection of the tumor and any involved structures.