Table 1.

Variable presentation in parathyroid cancer. Parathyroid hormone, PTH.

Normocalcemic (Serum Ca < 10.5 mg/dL)	Hypercalcemic	Hypercalcemic Crisis (Serum Ca > 14 mg/dL)
Can be asymptomatic, may have palpable mass	Usually symptomatic, gastrointestinal disturbances, renal stones or fatigue, neurocognitive issues	Can present in extremis, with altered sensorium or stupor
Present at more advanced stages	Should have a high index of suspicion based on calcium and PTH levels	Aggressive management with hydration, bisphosphonates, calcitonin or denosumab
Higher tendency to metastasize		Expedite surgery