Clinical Problem Solving: Pathology |

Pathology Quiz Case 2

Raja R. Seethala, MD; John H. Yim, MD; Jennifer L. Hunt, MD
Arch Otolaryngol Head Neck Surg. 2006;132(12):1391. doi:10.1001/archotol.132.12.1391.
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A 65-year-old woman presented incidentally with a high-normal serum calcium level (10.80 mg/dL [2.70 mmol/L]; reference range, 8.5-10.8 mg/dL [2.12-2.70 mmol/L]) after undergoing routine blood work 4 months earlier. The results of her physical examination were essentially unremarkable. A serum intact parathyroid hormone level was markedly elevated at 165 pg/mL (17.4 pmol/L) (reference range, 12-65 pg/mL [1.3-6.8 pmol/L]), and a 24-hour urinary calcium level was elevated at 425 mg (10.6 mmol/d) (reference range, 100-300 mg [2.5-7.5 mmol/d]). A sestamibi scan (Figure 1) demonstrated persistent accumulation of technetium Tc 99m tracer just right of the midline, posteroinferior to the thyroid lobes.

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