Question
A 60 year old patient presents with bone pain and easy fatigue. Serum calcium is elevated, phosphate is low and SAP is elevated. X-ray shows diffuse osteoporosis. Which of the following investigations will be useful for the confirmation of diagnosis?
| A. |
PET scan |
| B. |
Sestamibi scan |
| C. |
Bone marrow biopsy |
| D. |
Triphasic bone scan |
|
Correct Answer � B Explanation |
 |
Primary Hyperparathyroidism (PHPT)
Etiology:
– Parathyroid adenoma (80–85%)
– Parathyroid hyperplasia
– Parathyroid carcinoma (rare)
Biochemical Features:
– ↑ Calcium
– ↓ Phosphate
– ↑ Parathyroid hormone (PTH)
– ↑ Alkaline phosphatase (bone turnover marker)
Symptoms:
– Bone pain, osteoporosis from ↑ bone resorption
– Fatigue, weakness
– Nephrolithiasis
– Neuropsychiatric changes
– Classic mnemonic: “Bones, stones, groans, & psychiatric overtones”
Imaging:
– X-ray: Osteopenia, subperiosteal bone resorption (phalanges)
– Sestamibi scan: To localize adenoma
Treatment:
– Surgical removal of adenoma
– Monitoring if asymptomatic