PMC3890227_01
The legs of the patient showing muscle wasting, knock knees, bilateral eversion deformity at ankle joints, and flat feet
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f1
SDS: -0.22], widening of wrists, genu valgum, bilateral eversion deformity at the ankle joints along with flat feet, generalized muscle wasting (more prominent in the lower limb), and proximal muscle weakness (Figure 1).
Radiograph of the hands and forearms showing generalized osteopenia, widening of the distal ends of the radius and ulna along with cupping, fraying and splaying of the metaphyses
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f2
She was prepubertal by Tanner sexual maturity staging. Skeletal radiography revealed generalized osteopenia, widening of the distal ends of the long bones (radius, ulna, femur, and tibia) along with splaying, cupping and fraying (Figures 2, 3).
Radiograph of the ankle joints showing widening of the lower end of tibia, splaying and fraying of the metaphyses along with eversion deformity of the ankle joints
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f3
She was prepubertal by Tanner sexual maturity staging. Skeletal radiography revealed generalized osteopenia, widening of the distal ends of the long bones (radius, ulna, femur, and tibia) along with splaying, cupping and fraying (Figures 2, 3).
99mTc-sestamibi parathyroid scan revealing increased uptake in the right inferior thyroid region, a finding which persisted on delayed imaging at 90 minutes and 3 hours
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f4
Re-evaluation at 16 weeks revealed hypercalcemia, worsening of the hypophosphatemia, persistence of the elevated parathyroid hormone (PTH) along with normalization of serum 25-hydroxy-vitamin-D [25(OH)D] (Table 1). 99mTc-sestamibi scan revealed increased uptake at the lower pole of the right lobe of the thyroid gland, a finding which persisted during delayed imaging at 90 minutes and 3 hours and was suggestive of right inferior parathyroid adenoma (Figure 4).
Histopathology of the surgically resected right inferior parathyroid showing sheets of cells without any evidence of capsular invasion (low magnification)
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f5
Histopathology revealed a homogenous cell population arranged in nests without any evidence of capsular or vascular invasion and absence of mitotic figures suggestive of chief cell type parathyroid adenoma (Figures 5a,5b).