Diagnosis and management of parathyroid carcinoma: a state-of-the-art review

P. Roser, B.M. Leca, C. Coelho, K.-M. Schulte, J. Gilbert, E.E. Drakou, C. Kosmas, L.L. Chuah, H. Wassati, A.D. Miras, J. Crane, S.J.B. Aylwin, A.B. Grossman, G.K. Dimitriadis

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Parathyroid carcinoma is one of the least common endocrine malignancies and accounts for approximately 1% of all patients with primary hyperparathyroidism. A systematic review of peer-reviewed literature published between January 2000 and March 2022 via Medline, Embase, Cochrane Central Register of Controlled Trials, EudraCT, ClinicalTrials.gov, CINAHL and SCOPUS was conducted. Manuscripts were eligible if they included data on adult non-pregnant populations with parathyroid carcinoma. No restrictions regarding interventions, comparators or duration of follow-up were imposed. Single case reports, reviews or meta-analyses were excluded. Outcomes of interest were molecular pathogenesis, clinical presentation, differential diagnosis, treatment, follow-up and overall survival. Study quality was evaluated using the Newcastle–Ottawa Scale for observational studies.

This review included 75 studies from 17 countries, reporting on more than 3000 patients with parathyroid carcinoma. CDC73 mutation has been recognised as playing a pivotal role in molecular pathogenesis. Parathyroid carcinoma typically presents with markedly increased calcium and parathyroid hormone levels. The most frequently described symptoms were bone and muscle pain or weakness. En bloc resection remains the gold standard for the surgical approach. The 5-year overall survival ranged from 60 to 93%, with resistant hypercalcaemia a significant cause of mortality. Emerging evidence indicating that targeted therapy, based on molecular biomarkers, presents a novel treatment option. The rarity of PC and need for personalised treatment warrant multidisciplinary management in a ‘centre of excellence’ with a track record in PC management.
Original languageEnglish
Article numbere220287
JournalEndocrine-Related Cancer
Issue number4
Early online date5 Jan 2023
Publication statusPublished online - 5 Jan 2023

Bibliographical note

Publisher Copyright:
© 2023 the author(s) Published by Bioscientifica Ltd. Printed in Great Britain.


  • parathyroid carcinoma
  • hypercalcaemia;
  • hyperparathyroidism
  • malignancy
  • systematic review
  • hypercalcaemia


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