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Case of the Week 328

What's the most likely diagnosis?

  • 51 year-old man with elevated creatinine

  1. Psoriasis
  2. Metastatic disease
  3. Sarcoid
  4. Hyperparathyroidism
  5. Reiter's syndrome

Additional Images - Frontal view of same hand


Additional Images

Frontal view right hand


4. Hyperparathyroidism

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Primary hyperparathyroidism

  • Overproduction of parathyroid hormone (PTH) with associated hypercalcemia
  • Most frequent cause: single adenoma in 85% of cases
  • Clinical: Bones (osteopenia, brown tumors), stones (renal calculi) and abdominal groans (ulcer disease)
  • Laboratory: increased parathormone level with hypercalcemia is diagnostic of primary hyperparathyroidism
  • Imaging of the parathyroid glands: radiolabeled technetium 99m sestamibi persists in adenomas on nuclear scans
  • Brown tumors are more common than in secondary form
  • Treatment: Symptomatic patients are usually treated by surgically removing abnormal gland(s)


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This Week

51 year-old man with elevated creatinine

Part 1 of a 2 part review of 3 different pulmonary diseases that share the acronym "PIE:" Pulmonary Interstitial Edema, Pulmonary Interstitial Emphysema and Pulmonary Infiltrates with Eosinophilia.


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