Sciatica masquerading parathyroid carcinoma

Abstract

Primary hyperparathyroidism is detected in the Western world in an asymptomatic stage due to routine calcium screening. In India, patients are still diagnosed with various symptoms such as bone disease and renal disease and only 5.6% are in the asymptomatic stage. A 48-year-old female came with complaints of right hip pain of 1-month duration. She had low back pain a year ago radiating to both thighs. The pain was not suggestive of inflammatory arthritis, and the autoimmune profile was negative. The pain progressively worsened, and the patient became bedridden. General examination revealed left-sided neck swelling that moved with deglutition. Right lower-limb movement was restricted by severe pain. Magnetic resonance imaging of the lumbar spine revealed a diffuse altered signal intensity involving the entire spine, bilateral pelvis, and femur with hypointense on both T1 and T2 images suggestive of marrow infiltrative disorder. Her serum calcium was 12.7 mg/dl and serum phosphorus was 1.9 mg/dl. The patient's alkaline phosphatase was 2919 IU/L. Her parathyroid hormone level was 2095 pg/ml. The patient was diagnosed to have hyperparathyroidism. 99mTc-sestamibi parathyroid single-photon emission computed tomography–computed tomography was suggestive of left superior parathyroid adenoma. The surgical endocrinologist did a left superior parathyroidectomy. Postoperatively, she developed hypocalcemia. It was managed with intravenous calcium infusion, oral calcium, and oral calcitriol. Six weeks after surgery, the pain in the right hip decreased significantly, and she was able to walk without support. Histopathological examination of the removed parathyroid was suggestive of parathyroid carcinoma. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge.