{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T19:31:52Z","timestamp":1794339112376,"version":"4.9.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T00:00:00Z","timestamp":1643587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006390","name":"Universit\u00e9 de Lausanne","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006390","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Refractory hypercalcemia is one of the major complications of parathyroid carcinoma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case report<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>In case of parathyroid carcinoma, <jats:italic>en-bloc<\/jats:italic> 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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2021.794988","type":"journal-article","created":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T14:29:20Z","timestamp":1643639360000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Denosumab for the Treatment of Hypercalcemia in a Patient With Parathyroid Carcinoma: A Case Report"],"prefix":"10.3389","volume":"12","author":[{"given":"Abdallah","family":"Roukain","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heba","family":"Alwan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Bongiovanni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerasimos P.","family":"Sykiotis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Kopp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,1,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ando.2015.03.003","article-title":"Parathyroid Carcinoma: Challenges in Diagnosis and Treatment","volume":"76","author":"Betea","year":"2015","journal-title":"Annales D\u2019endocrinol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.5694\/mja12.11243","article-title":"Resistant Hypercalcaemia in Metastatic Parathyroid Carcinoma","volume":"198","author":"Bowyer","year":"2013","journal-title":"Med J Aust"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-3031","article-title":"Denosumab for Management of Parathyroid Carcinoma-Mediated Hypercalcemia","volume":"99","author":"Vellanki","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/BF02819737","article-title":"Parastruma Maligna Aberrata","volume":"100","author":"de Quervain","year":"1909","journal-title":"Deutsche Z F Chirurgie"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-14-0166","article-title":"Refractory Hypercalcaemia Secondary to Parathyroid Carcinoma: Response to High-Dose Denosumab","volume":"171","author":"Karuppiah","year":"2014","journal-title":"Eur J Endocrinol"},{"key":"B6","article-title":"Parathyroid Carcinoma: Biochemical and Pathologic Response to DTIC","volume":"96","author":"Calandra","year":"1984","journal-title":"Surgery"},{"key":"B7","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1001\/archinte.1984.00350140229032","article-title":"Successful Combination Chemotherapy for Metastatic Parathyroid Carcinoma","volume":"144","author":"Bukowski","year":"1984","journal-title":"Arch Internal Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(98)00098-4","article-title":"Parathyroid Carcinoma\u2013The Princess Margaret Hospital Experience","volume":"41","author":"Chow","year":"1998","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11819","article-title":"Parathyroid Carcinoma: Is There a Role for Adjuvant Radiation Therapy","volume":"98","author":"Munson","year":"2003","journal-title":"Cancer"},{"key":"B10","doi-asserted-by":"publisher","first-page":"w14484","DOI":"10.4414\/smw.2017.14484","article-title":"Osteoporosis Drug Treatment: Duration and Management After Discontinuation. 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