Case study of primary hyperparathyroidism 20.01.2020

Endocrine grand rounds

Case 3o-10-98:A 68 year-old lady with a history of bone and muscle pain presented with parathyroid adenoma

Dr dehghan and Dr saberian

Chief complaint and present illness

• CC:Skeletal and muscle pain(right lower limb)
• PI:the patient is a 68 years old woman married to had 6 children and lives in mashhad,source of history was her dauther but not reliable.
• 2 years ago(in 1396)First presented to a physician with a history of confusion and delirium resolved rapidly.becauase of this presentation routine laboratory was performed that showed mild hypercalcemia(ca:10.3) and subclinical hyperthyroidiam(TSH:0.19,T4:97) and other laboratory was normal.
• The patient had generalized muscle pain specially in neck and shoulders.
• She hasn’t remember pattern of pain .because of this symptom and laboratory report, parathyroid scan with MIBI was done. The scan showed no evidence of abnormal parathyroid tissue in the thyroid bed, a focal area of increased radiotracer uptake in the upper mediastinum.
• The patient treated with cinacalcet and methimazol with unknown diagnosis???
• Because of severe muscle and skeletal pain she consumed multiple NSAIDS  such as diclofenac and hadn’t proper F/U.
• In 1397 Neck and shoulder pain was improved but lower limb specially right thigh pain was begun.
• Pain was aggravated especially at night.she had claudication and muscle pain and inability to get up from the ground because of sever pain.
• In 1397/1/26 , repeated parathyroid scintigraphy with TC-99-MIBI showed negative for either parathyroid adenoma or hyperplasia.