Unusual presentation in a case of primary hyperparathyroidism

Area of Science:

• Endocrinology
• Oncology
• Nuclear Medicine

Background:

• Primary hyperparathyroidism (PH) is a condition characterized by excessive parathyroid hormone (PTH) secretion.
• Severe PH can manifest with skeletal complications, such as osteitis fibrosa cystica, which is now infrequently observed.
• Differential diagnosis for bone lesions often includes metastatic neoplasms, necessitating advanced imaging.

Observation:

• A patient presented with severe PH and osteitis fibrosa cystica, a rare clinical manifestation.
• Bone scintigraphy revealed multiple areas of increased uptake, prompting investigation for bone secondarisms.
• FDG-PET/CT showed diffuse increased uptake in bones and a focal uptake in the left thyroid region.

Findings:

• Elevated parathyroid hormone (PTH) levels were unexpectedly discovered during parathyroid function studies.
• Further investigations confirmed the diagnosis of primary hyperparathyroidism.
• A parathyroid adenoma was localized to the lower left parathyroid gland.

Implications:

• This case underscores the importance of considering rare presentations of common endocrine disorders.
• Advanced imaging like FDG-PET/CT can aid in diagnosing complex cases and differentiating from malignancy.
• Timely diagnosis and localization of parathyroid adenomas are crucial for effective management of PH.