Diagnosis not to be missed: primary hyperparathyroidism

Abstract

A 67-year-old lady wiith history of recurrent renal stones presented with polyarthritis, multiple bone pain and chronic duodenal ulcer. Her skeletal problem was initially attrihuted to osteoarthritis, gouty arthritis and osteoporosis. The diagnosis of primary hyperparathyroidism was suspected six years later by a high serum calcium level detected on routine screening; and was confirmed by an elevated serum parathyroid hormone level and the finding of a parathyroid adenoma on neck exploration. The challenge of diagnosing this potentially treatable disorder in the presence of multiple pathology in old age was discussed.