Hyperparathyroidism Mimicking Metastatic Bone Disease: A Case Report and Review of Literature

Abstract

Multiple osteolytic lesions are usually associated with metastatic involvement of the bone; however, metabolic bone diseases should also be included in the differential diagnosis. In this study, we describe a case of primary hyperparathyroidism (PHPT) with multiple osteolytic lesions that was diagnosed initially as having metastatic bone involvement. The laboratory results showed hypercalcemia and raised alkaline phosphatase along with fibrosis in the bone marrow biopsy with no increase in tumor markers and normal serum protein electrophoresis. The parathyroid hormone levels were high, which pointed toward a diagnosis of PHPT. Sestamibi scan revealed uptake at the level of the left inferior pole of the thyroid gland, which was suggestive of parathyroid adenoma. The possibility of hyperparathyroidism should be kept in mind when a patient presents with multiple osteolytic lesions and hypercalcemia.

Severe Primary Hyperparathyroidism Caused by Parathyroid Carcinoma in a 13‐Year‐Old Child; Novel Findings From HRpQCT

“…This difference could be explained by the fact that the cortex may be more metabolically active in children, especially during pubertal phases such as in the case of our patient, wherein the evolution of cortical porosity is an adaptation mechanism to maintain mechanical strength. In both studies, there was no report of any osteolytic lesions, which may also be explained by this mechanism, but is most likely caused by the higher PTH levels attributed to the carcinoma versus parathyroid adenomas noted in published adult studies …”

“…In both studies, (33,34) there was no report of any osteolytic lesions, which may also be explained by this mechanism, but is most likely caused by the higher PTH levels attributed to the carcinoma versus parathyroid adenomas noted in published adult studies. (39)(40)(41) It is important to note, however, that the interpretation of HRpQCT bone properties in the context of healthy controls is currently limited for the HRpQCT version 2 of the scanner. The available normative data for children in the literature have only reported results from version 1 scanners, (42) which use a slightly lower resolution (82-μm isotropic voxel size) and yield multiple parameters that are not directly measured, but are derived from bone volume fraction and trabecular density.…”

Giant parathyroid adenoma and hungry bone syndrome in MEN1 syndrome: A case report

“…Radiological investigations are also crucial in assessing the skeletal involvement associated with hyperparathyroidism and hungry bone syndrome. Radiographs, CT, and bone scintigraphy can be employed to evaluate the presence of osteopenia, osteoporosis, fractures, or other skeletal abnormalities like osteitis fibrosa cystica associated with hyperparathyroidism and hungry bone syndrome [12] , [13] .…”

Complimentary Role of [18F]FDG and [18F]NaF-PET/CT in Evaluating Synchronous Thyroid Carcinoma and Parathyroid Adenoma with Brown Tumors

“…[18F]NaF-PET/CT was performed which was suggestive of metabolic superscan pattern. 4 A focal [18F]FDG uptake in incidental thyroid lesions carry a high risk of malignancy, on the contrary the risk is low in the case of diffuse [18F]FDG uptake. 5 Incidental [18F]FDG avidity in parathyroid adenoma has been reported in literature.…”