Endocrine Abstracts

We present the case of a 60 year old female, who was referred from the breast clinic after having a radical mastectomy and radiotherapy with a raised calcium of 2.78. She had a negative CT chest/abdomen/pelvis and her parathyroid hormone was raised at 19.7. She had a previous history of renal cancer treated with nephrectomy and was known to have the variant of the BRCA 1 gene. Her main symptom was fatigue post treatment. Her calcium: creatinine clearance ratio was 0.0104. The vitamin D was initially 44 but post treatment it increased to 54 but PTH remained raised at 23.5. Her calcium remained raised 2.68-2.83. The ultrasound of her parathyroid and kidneys did not reveal any abnormalities. Her DEXA scan showed osteopenia in her forearms only. In view of her BRCA gene she was keen for bilateral mastectomy and was on the waiting list. A Sestamibi scan was requested but due to shortage of the assay there was a delay in her getting this. She proceeded to have the breast surgery. Post operatively the Sestamibi showed a functioning parathyroid adenoma posterior to the lower pole of the right thyroid lobe. It also showed a non-avid hypoattenuating liver lesion and a T9 sclerotic bone lesion, suggestive of metastasis. MRI spine and liver confirmed the appearances were in keeping with multiple vertebral and hepatic metastases. We believe that this is the first reported case of sestamibi detecting a functioning parathyroid adenoma as well as liver and bone metastasis. Previous case reports found metastatic disease in sestamibi scans for other conditions but none with a functioning parathyroid adenoma and metastatic disease reported. Her calcium has normalised and she is on denosumab every 6 weeks.