Vanishing metatarsal: a rare manifestation of primary hyperparathyroidism

Description

A 31-year-old woman presented with a history of bone pains, difficulty in walking and painless swelling of the left foot for the last 1 year (figure 1). X-ray of the left foot showed multiple lytic lesions in metatarsal bones and the absence of proximal half of shaft of second metatarsal. Biochemistry results revealed corrected serum calcium 11.2 mg/dL, phosphate 2.0 mg/dL, alkaline phosphatase 1049 IU/mL, intact parathyroid hormone (iPTH) 2543 pg/mL, 25-hydroxyvitamin D 16.2 ng/mL, and serum creatinine 0.6 mg/dL. She had no history of pancreatitis or evidence of renal/gall stone disease. The skeletal survey showed multiple osteitis fibrosa cystica (OFC) lesions, pathological fracture of shaft of the left femur and salt and pepper appearance of the skull (figure 2a, b, c). Sestamibi scan revealed right inferior parathyroid adenoma measuring 3.0x2.9x2.2 cm. Based on the above findings, a diagnosis of primary hyperparathyroidism (PHPT) was made and she underwent parathyroid adenectomy. Tumour weighed 4 g and histopathology was...

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