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Pia Roser Department of Endocrinology ASO/EASO COM, King′s College Hospital NHS Foundation Trust, London, UK
Department of Endocrinology and Diabetes, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

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Bianca M Leca University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK

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Claudia Coelho Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK

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Klaus-Martin Schulte Department of Endocrine Surgery, King's College Hospital NHS Foundation Trust, London, UK
Academic Department of Surgery, Australian National University, Canberra, Australia

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Jackie Gilbert Department of Endocrinology ASO/EASO COM, King′s College Hospital NHS Foundation Trust, London, UK

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Eftychia E Drakou Department of Clinical Oncology, Guy's Cancer Centre - Guy's and St Thomas' NHS Foundation Trust, London, UK

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Christos Kosmas Department of Medicine, Division of Medical Oncology-Hematopoietic Cell Transplant Unit, Metaxa Memorial Cancer Hospital, Piraeus, Greece

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Ling Ling Chuah Department of Endocrinology ASO/EASO COM, King′s College Hospital NHS Foundation Trust, London, UK

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Husam Wassati Department of Radiology, King’s College Hospital NHS Foundation Trust, Princess Royal University Hospital, London, UK

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Alexander D Miras Section of Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism, Imperial College London, London, UK

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James Crane Department of Endocrinology ASO/EASO COM, King′s College Hospital NHS Foundation Trust, London, UK

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Simon J B Aylwin Department of Endocrinology ASO/EASO COM, King′s College Hospital NHS Foundation Trust, London, UK

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Ashley B Grossman Green Templeton College, University of Oxford, Oxford, UK
Centre for Endocrinology, William Harvey Institute, Barts and the London School of Medicine, London, UK
Neuroendocrine Tumour Unit, Royal Free Hospital, London, UK

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Georgios K Dimitriadis Department of Endocrinology ASO/EASO COM, King′s College Hospital NHS Foundation Trust, London, UK
Obesity T2D and Immunometabolism Research Group, Faculty of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK
Division of Biomedical Sciences - Reproductive Health, Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry, UK

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Parathyroid carcinoma is one of the least common endocrine malignancies and accounts for approximately 1% of all patients with primary hyperparathyroidism. A systematic review of peer-reviewed literature published between January 2000 and March 2022 via Medline, Embase, Cochrane Central Register of Controlled Trials, EudraCT, ClinicalTrials.gov, CINAHL and SCOPUS was conducted. Manuscripts were eligible if they included data on adult non-pregnant populations with parathyroid carcinoma. No restrictions regarding interventions, comparators or duration of follow-up were imposed. Single case reports, reviews or meta-analyses were excluded. Outcomes of interest were molecular pathogenesis, clinical presentation, differential diagnosis, treatment, follow-up and overall survival. Study quality was evaluated using the Newcastle–Ottawa Scale for observational studies.

This review included 75 studies from 17 countries, reporting on more than 3000 patients with parathyroid carcinoma. CDC73 mutation has been recognised as playing a pivotal role in molecular pathogenesis. Parathyroid carcinoma typically presents with markedly increased calcium and parathyroid hormone levels. The most frequently described symptoms were bone and muscle pain or weakness. En bloc resection remains the gold standard for the surgical approach. The 5-year overall survival ranged from 60 to 93%, with resistant hypercalcaemia a significant cause of mortality. Emerging evidence indicating that targeted therapy, based on molecular biomarkers, presents a novel treatment option. The rarity of PC and need for personalised treatment warrant multidisciplinary management in a ‘centre of excellence’ with a track record in PC management.

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