Imaging features of primary hyperparathyroidism

Hyperparathyroidism can be primary, secondary or tertiary depending on its aetiology. Parathyroid adenoma accounts for 80% of cases of primary hyperparathyroidism. We report a case of a 41-year-old female patient presented with severe osteoporosis and pathological fracture of right acetabulum and left intertrochanteric region. The patient had diffuse osteoporosis and multiple well-defined lytic lesions. A diagnosis of hyperparathyroidism apart from multiple myeloma and metastasis was made based on the findings of diffuse osteoporotic changes with multiple lytic lesions. A skeletal survey was performed in view of the pathological fracture of the femur; findings of the skeletal survey favoured the diagnosis of hyperparathyroidism. An ultrasound of the neck was performed to look for the cause and a parathyroid adenoma was picked up in the inferior aspect of the left lobe of the thyroid gland. CT of the neck was also performed for preoperative localisation of the lesion. Based on these findings diagnosis of primary hyperparathyroidism due to parathyroid adenoma was made. The patient underwent parathyroidectomy and perioperative and histopathological findings confirmed the preoperative diagnosis.