61 y/o man CKD on hemodialysis for 11 yr & gout
received ca-carbonate/calcitriol/EPO /allopurinol
Stress FX /bone deformity/osteoporesis
Pancytopnea/spleenomegally
High ca/alk ph/pth ?Parathyroid adenoma in MIBI
What is diagnosis ?
What is proper management?