Breast Cancer Patient With High Ca And PTH Levels. Can Any Endocrinologist Suggest?

Posted on Fri, 12 Jul 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Fri, 12 Jul 2013 Answered on

Thu, 22 Aug 2013 Last reviewed on

Question : Hi,
I would like to ask my question to Endocrinologist with reference to the discussion I have been having with Dr. XXXXXXX on your panel. Please refer the discussion thread WWW.WWWW.WW

This is about my mother who is Stage 4 breast cancer patient with bone mets (Only- no soft tissue involvement), recently she has been having high Ca and PTH levels.
Please find attached scan reports:
1. Brain, Chest, Abdomen and Pelvis CT scan - All normal
2. Ca and PTH report- both high
3. Parathyroid scans:
- USG Neck -suggest parathyroid adenoma
- CT neck- suggest parathyroid adenoma
- Te Thyroid and Te MIBI parathyroid scan- do not suggest parathyroid.

Our Endocrinologist is still skeptical about parathyroid as he feels Alkaline phosphatase levels are normal and he feels high Ca is result of bone mets. But Onco physician and surgeon are confident about parathyroid. Can Endocrinologist please advise us as yes or no in order to proceed with surgery to remove adenoma ?

Answered by Dr. Rahul Tawde (8 hours later)

Hi XXXXXXX ,

Thanks for writing in.

If high Ca was due to bone mets, it wouldn't have resulted in high PTH. High ca, high PTH with localisation on CT &USG suggest parathyroid adenoma.

Negative MIBI could be due to small size of tumor. Serum phosphate if low corroborates hyperparathyroidism. Alkaline phosphatase can be normal in early stages but as your endo rightly feels, its rather unusual for ALP levels to be normal in hyperparathyroid patients.

Overall picture however fits into hyperparathyroidism; so in my opinion surgery is the right option in this case, although there are some unusual features.

Hope this helps. Let me know if you need clarifications.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Rahul Tawde (2 days later)

Dear Dr. XXXXXXX

Thank you for your advise. My mother got operated last Saturday for adenoma removal and within 4 hours he Ca level came down to 8.2 from 10.5. We repeated Ca level after 24 hours and it was 8.3. Can we now surely say that Ca level was due to adenoma? We are waiting for the tumor histopath, expected by Thursday.

Thanks again you advise certainly helped.

Regards,
XXXX

Answered by Dr. Rahul Tawde (1 hour later)

Thanks again. Yes surely. It appears so. If low ca is accompanied by a fall in PTH levels also, then it almost confirms the successful adenoma removal. So things have moved in right direction. Lets wait for the HPE report.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Rahul Tawde (2 days later)

Hello Dr. Shivaprasad- here is an update:

Pre operative PTH was 45 with Ca 10.5
Post operative PTH is 20 with Ca 8.7

Can you now confirm the cause of high Ca?

Answered by Dr. Rahul Tawde (13 hours later)

PTH has fallen by 50%. And calcium has got back to normal. So reports are very much suggestive of PTH dependent hypercalcemia. So things are looking good. HPE will resolve this issue further.
Shivaprasad

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rahul Tawde (5 hours later)

Hello Doctor,

Histopath report has come and it says benign tumor; suggestive of parathyroid adenoma. Can we conclude now?

Regards,
XXXX

Answered by Dr. Rahul Tawde (18 hours later)

Yes, This confirms the diagnosis of hyperparathyroidism. Doctors have taken right decisions to reach this stage.
Repeat PTH and Calcium after 3 months just to reconfirm they are indeed in normal range.
Shivaprasad

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rahul Tawde (4 days later)

Hello Dr. XXXXXXX

Since the removal of adenoma my mother is complaining about dry mouth and low saliva which makes it difficult to swallow the food. Is is it common to have after surgery? Anything you would suggest?

Answered by Dr. Rahul Tawde (40 hours later)

Hi,
Thanks again. I don't think these symptoms are in any way related to removal of adenoma. Could be side effects of drugs given during anesthesia. Should improve gradually, if so. Meanwhile ask her to increase water intake. Nothing else is required as of now.

Shivaprasad

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rahul Tawde (29 hours later)

Thank you Doctor.

Answered by Dr. Rahul Tawde (20 hours later)

Fine.Thank you.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar