Parathyroid carcinoma discovered in young trauma victim during intensive care management

Abstract

Parathyroid gland carcinoma is uncommon disease, accounting less than 1% among the cases of primary hyperparathyroidism. There has been reported variations in prevalence between the nations, with higher occurence in Japan and Italy, according to their referral centers. Parathyroid cancer occurs mostly in patients above 30 years, but no sex differences have been noticed. Clinical signs correspond to symptoms of hypercalcaemia, which is usually severe, due to high production of parathyroid hormone in mostly functional tumors. Palpable mass in the neck and osteoporosis are present in about 50% of the cases. We report a case of 24-year old female victim of traffic accident, suffering severe traumatic injuries- intracerebral and brainstem bleeding and contusions, together with femoral fracture, in which intensive care management simptoms suspicious to parathyroid carcinoma have been observed. Further imaging, laboratory findings, and clinical signs confirmed diagnosis. Surgery, with „en bloc“ excision of the node together with adherent tissue has been performed. Definite histopathology finding approved parathyroid carcinoma. Clinical signs and laboratory findings normalized in the next period, and patient was discharged from our intensive care. This case indicates that close monitoring of clinical signs, biochemical findings together with imaging modalities available, help not to miss such rare diseases, which might be masked by primary trauma.