This protocol addresses primary hyperparathyroidism (PHPT) in the specific setting where parathyroid carcinoma is suspected — either before surgery or at the time of the operative finding. Because this situation is rare and carries distinct management implications, it warrants a specialised approach from the outset.
Parathyroid carcinoma accounts for approximately 0.5% of all PHPT cases, making it an uncommon but important cause of the condition. When malignant parathyroid disease is suspected — whether on preoperative assessment or intra-operatively — early consultation from an experienced endocrine surgery unit is essential to guide both the operative strategy and the pathway that follows.
Where disease persists, adjuvant therapy is evaluated through a structured multidisciplinary forum. One modality under consideration involves external beam radiotherapy; other approaches may also be relevant depending on local resources. The complete algorithm, options, and decision pathway are set out in the full protocol.
DOI: 10.1111/cen.14650
Parathyroid carcinoma is uncommon (approximately 0.5% of all PHPT cases).
Where there is preoperative or intra-operative suspicion of parathyroid carcinoma, consultation from an experienced endocrine surgery unit should be obtained.
Adjuvant therapy is reserved for persistent disease and should be discussed in a multidisciplinary forum.
External beam radiotherapy may have some benefit as a palliative manoeuvre.
Palliative or compassionate use of chemotherapeutics/other novel agents may be employed depending on local resources and enrolment in clinical trials should be encouraged.
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