A 45-year-old man was admitted to the hospital with a history of anorexia, fatigue, and thirst. 10 years ago he was treated for urinary calculi. Examination Laboratory evaluation showed a serum calcium level of 14.7 mg/dL (Normal range: 8.0 - 10.4 mg/dL). Serum intact parathyroid hormone level of 3844.0 pg/mL (normal range: 10.3 to 65.9). Ultrasonography of the neck revealed a 2.2-cm solid mass posterior to the inferior aspect of the left lobe of the thyroid.
Technetium-99m–labeled sestamibi scintigraphy showed abnormal uptake in the left parathyroid gland. It also showed multiple sites of subperiosteal resorption involving the phalanges (arrowheads) and tuftal resorption (asterisks). What is the most likely diagnosis? *This case is from Docplexus editorial team for educative purpose only. Source: NEJM Stay Connected, the answer will be posted in the next 48h!
