case_images: PMC3786150_01
case_images: Physical findings at first contact with general surgeon
case_images: PAMJ-15-45-g001.jpg
case_images: PMC3786150_01_PAMJ-15-45-g001.jpg
case_images: F0001
case_images: At first consultation by the general surgeon (Figure 1), physical examination revealed a young man, conscious and alert, in pains, wasted, with a global reduction in muscle bulk.
case_images: Sestamibi parathyroid scintigraphy revealed an increased focal uptake
case_images: PAMJ-15-45-g002.jpg
case_images: PMC3786150_01_PAMJ-15-45-g002.jpg
case_images: F0002
case_images: The serum parathyroid hormone level was 202.8 pmol/l (normal is 1.6-6.9 pmol/l). 99mTc Sestamibi parathyroid scintigraphy (Figure 2, Figure 3) revealed an increased focal uptake.
case_images: A) bony changes - salt and pepper appearance of the skull; B) bony changes - osteoporotic changes of the left humerous (with cystic changes on the head); C) bony changes - demineralized right femur (also shows fixed pathologic fracture)
case_images: PAMJ-15-45-g003.jpg
case_images: PMC3786150_01_PAMJ-15-45-g003.jpg
case_images: F0003
case_images: The serum parathyroid hormone level was 202.8 pmol/l (normal is 1.6-6.9 pmol/l). 99mTc Sestamibi parathyroid scintigraphy (Figure 2, Figure 3) revealed an increased focal uptake. He is currently 15 months post-surgery, he is being rehabilitated as an outpatient, he is pain free, more mobile and the serum calcium has remained normal (Figure 3).