Endocrine Abstracts (2012) 29 P408

The diagnostic challenge of a parathyroid adenoma undetectable by Tc-99m Sestamibi scintigraphy or computed tomography in a patient with newly diagnosed sarcoidosis and hypercalcaemia

J. El-Sheikha1,2, I. Hutchinson2 & A. Pettit2

1NHS, Hull, UK; 2Airedale General Hospital, Steeton, UK.

Hypercalcaemia is a common finding in numerous diseases processes but is non-specific to its cause. We report a case of a 55-year-old lady with known sarcoidosis who developed hypercalcaemia and elevated parathyroid hormone due to a parathyroid adenoma. Both these disease processes are independently associated with hypercalcamia, but it is unusual to have both in combination and difficult to establish which is the primary cause. In our case the diagnosis was complicated by a negative Technetium Sestamibi and computed tomography (CT) scan specifically looking for a parathyroid adenoma. This led to an incorrect diagnosis of sarcoid hypercalcaemia with tertiary hyperparathyroidism secondary to osteomalaciea. This diagnosis was reconsidered when a trial of steroids showed an unexpectedly poor response. A lesion noted in the patients CT scan behind the patients left clavicle was investigated further by surgical exploration. Although this lesion was identified as a sarcoid granuloma, the opportunity was taken to explore the patients thyroid. A solitary parathyroid adenoma was detected and following parathyroidectomy her hypercalcaemia resolved. This rare combination highlights the importance good clinical judgment and a healthy scepticism of advanced investigations.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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