PMC4660009_01
Abdominal computed tomography (CT) on admission. (a) Diffuse pancreatic calcifications; (b) bilateral kidney calcifications on axial computed tomography. Findings are marked with white arrow heads.
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fig1
Skeletal X-rays showed skull with "salt and pepper" lesions, vertebral compression fractures, brown tumors within the left humerus, and profuse calcifications within the pancreas and kidneys (Figure 1).
Neck ultrasonography on admission. (a) Large echogenic mass dorsal to the right lobe of the thyroid gland. (b) Doppler effect showing polar vessel finding, present in most adenomas. Findings are marked with white arrow heads.
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fig2
Neck ultrasonography showed microcalcifications within a large echogenic mass, posterior to the right lobe of the thyroid gland of 33 x 14 x 14 mm, Figure 2.
Neck scintigraphies with 25 mCi of 99Tc-sestamibi with 0' and 120' wash-out sequences. (a) 2010 Admission Scintigraphy. 120' washout sequence shows residual capitation from right lower thyroid lobe suggesting a parathyroid adenoma. (b) 2013 postparathyroidectomy control scintigraphy. 120' wash-out sequence shows no apparent residual captation. Findings are marked with white arrow heads.
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fig3
A 25 mCi 99Tc-sestamibi scintigraphy reported persistence of the radionuclide material at 120 minutes in the right inferior parathyroid gland at the same location of the mass shown in the US, Figure 3.
(a) Corrected serum calcium during hospitalization and as outpatient. (b) Serum phosphate values during hospitalization and as outpatient. (c) Serum magnesium values during hospitalization and as outpatient. *Gray area represents reference values. **Vertical dotted line represents treatment beginning, which continued beyond last medical assessment at our institution.
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fig4
Serum calcium, phosphate, and magnesium levels during hospitalization and follow-up are shown in Figure 4.