Which combination of findings most strongly suggests parathyroid carcinoma rather than benign primary hyperparathyroidism?

• A Sestamibi-negative adenoma with mild hypercalcaemia and nephrolithiasis
• B Palpable neck mass, serum calcium above 14 mg/dL, and intact PTH more than five times the upper limit of normal ✓
• C Four-gland hyperplasia with a family history of MEN1
• D Osteoporosis alone with PTH twice the upper limit of normal

Explanation

Parathyroid carcinoma presents with severe biochemical disease: calcium typically above 13 to 14 mg/dL, PTH three to ten times normal, often a palpable hard neck mass in around half of patients, and frequently renal and skeletal involvement together. Benign adenomas rarely cause a palpable gland. Four-gland hyperplasia indicates multigland disease as in MEN1, and modest elevations favour benign disease. En bloc resection without capsular breach is the operative goal because seeding causes recurrence.

Reference: Schwartz's Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.