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      Osteosclerotic and osteolytic manifestations of hyperparathyroidism in a case of Tc99m SestaMIBI positive parathyroid adenoma


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          Primary hyperparathyroidism is the first differential diagnosis when a patient presents with asymptomatic hypercalcemia. The symptoms of hyperparathyroidism can be as grave as skeletal, cardiovascular, and neuropsychological changes. Skeletal manifestations are relatively common, and patient may present with generalized or focal bone pains, fragility fractures, subperiosteal bone resorption, and osteolytic lesions like brown tumors and salt and pepper appearance of the skull. However, focal osteosclerotic lesions of the skull are rare findings in hyperparathyroidism. Only a few cases of associated osteosclerosis are reported in the literature. Here, we report a case of Tc99m SestaMIBI positive parathyroid adenoma with coexisting osteolytic and osteosclerotic skull lesions on Tc99m methylene diphosphonate bone scan.

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          Primary hyperparathyroidism and heart disease--a review.

          Primary hyperparathyroidism (pHPT), caused by solitary parathyroid adenomas in 85% of cases and diffuse hyperplasia in most of the remaining cases, overproduces parathyroid hormone (PTH), which mobilizes calcium to the blood stream. Renal stones, osteoporosis and diffuse symptoms of hypercalcaemia, such as constipation, fatigue and weakness are well-known complications. However, in Western Europe and North America, patients with pHPT are nowadays usually discovered during an early, asymptomatic phase of the disease. It has been reported that patients suffering from symptomatic pHPT have increased mortality, mainly due to an overrepresentation of cardiovascular death. pHPT is reported to be associated with hypertension, disturbances in the renin-angiotensin-aldosterone system, and structural and functional alterations in the vascular wall. Recently, studies have indicated an association between pHPT and heart disease, and studies in vitro have produced a number of theoretical approaches. An increased prevalence of cardiac structural abnormalities such as left ventricular hypertrophy (LVH) and valvular and myocardial calcification has been observed. Associations have been found between PTH and LVH, and between LVH and serum calcium. LV systolic function does not seem to be affected in patients with pHPT, whereas any influence on LV diastolic performance needs further evaluation. The aim of this review is to clarify the connection between pHPT and cardiac disease.
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            Primary hyperparathyroidism with multiple osteosclerotic lesions of the calvarium.

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              Bone disease in chronic renal failure with particular reference to osteosclerosis.


                Author and article information

                Indian J Nucl Med
                Indian J Nucl Med
                Indian Journal of Nuclear Medicine : IJNM : The Official Journal of the Society of Nuclear Medicine, India
                Medknow Publications & Media Pvt Ltd (India )
                Jul-Sep 2015
                : 30
                : 3
                : 263-265
                [1]Department of Nuclear Medicine, VMMC and Safdarjung Hospital, New Delhi, India
                [1 ]Department of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, India
                Author notes
                Address for correspondence: Dr. Ravinder Singh Sethi, Department of Nuclear Medicine, H-Block, VMMC and Safdarjung Hospital, New Delhi - 110 029, India. E-mail: rssethi@ 123456yahoo.com
                Copyright: © Indian Journal of Nuclear Medicine

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Case Report

                Radiology & Imaging
                brown tumor,methylene diphosphonate bone scan,osteosclerotic skull lesion,parathyroid adenoma,primary hyperparathyroism,tc99m sestamibi


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