A Young Man With Hypercalcemia

Abstract

A well-developed man in his 20s presented to our hospital with a clinically significant elevation in serum calcium level to (14.1 mg/dL [reference range, 8.6-10.2 mg/dL]) found on routine laboratory tests. He was highly functional and denied abdominal pain, dysuria, anxiety, lethargy, and constipation. Findings from his physical examination were within normal limits. He did not have any palpable thyroid nodules or cervical lymphadenopathy. Given his elevated calcium level, parathyroid hormone (PTH) was drawn, and results returned significantly elevated at 1377 pg/mL (reference range, 10-65 pg/mL). Because of the extremely elevated PTH level, a technetium Tc 99m sestamibi single-photon emission computed tomographic/computed tomographic (SPECT/CT) scan was obtained, which identified a lesion in the location of the right inferior parathyroid gland, measured at 2.2 cm (Figure , A). In addition, CT showed associated lytic bone lesions of the left mandibular ramus, left scapula, and C5 vertebra (Figure , B). What is your diagnosis? A.Parathyroid carcinoma B.Multiple myeloma C.Primary bone tumor D.Osteitis fibrosa cystica Diagnosis D.Osteitis fibrosa cysticaThe patient underwent right inferior parathyroidectomy, with intraoperative return to normal PTH levels of 50 pg/mL after removal of the affected gland. He recovered without issues postoperatively. Final pathologic findings demonstrated a parathyroid adenoma weighing 5.9

A rare cause of lytic lesion: the brown tumors

“…5 They can occur in any location but are most common in the ribs, clavicle and pelvis. 6,7 Our case is characterized by an atypical and unique localization in humerus. As in our observation, on radiological examination they appear as osteolytic lesions with well-defined borders.…”