Get your Health question answered in 3 easy steps
A Doctor will be with you shortly
Ask a Doctor Now
135 Doctors are Online

Breast cancer patient with high Ca and PTH levels. Can any endocrinologist suggest?

User rating for this question
Excellent
Answered by

General & Family Physician
Practicing since : 1980
Answered : 1 Question
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 ?
Posted Thu, 15 Aug 2013 in Thyroid Problem and Hormonal Problems
 
 
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
 
Follow-up: Breast cancer patient with high Ca and PTH levels. Can any endocrinologist suggest? 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
 
Follow-up: Breast cancer patient with high Ca and PTH levels. Can any endocrinologist suggest? 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
 
Follow-up: Breast cancer patient with high Ca and PTH levels. Can any endocrinologist suggest? 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
 
Follow-up: Breast cancer patient with high Ca and PTH levels. Can any endocrinologist suggest? 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
 
Follow-up: Breast cancer patient with high Ca and PTH levels. Can any endocrinologist suggest? 29 hours later
Thank you Doctor.
 
 
Answered by Dr. Rahul Tawde 20 hours later
Fine.Thank you.
Above answer was peer-reviewed by
 
Share on Facebook
Share on Twitter
Share on Google+
Question is related to

The user accepted the expert's answer

Ask an Endocrinologist

© Ebix, Inc. All Rights Reserved.
All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. You should always speak with your doctor before you follow anything that you read on this website. Any health question asked on this site will be visible to the people who browse this site. Hence, the user assumes the responsibility not to divulge any personally identifiable information in the question. Use of this site is subject to our Terms & Conditions
Already Rated.
Your rating:

Ask a Doctor