A 47 year old lady is brought in after she slipped and fell on the ground. She was unable to get up due to severe pain in both hips. Close questioning reveals the presence of nocturia and constipation for several months. Her medical history is unremarkable and she is not on any drugs.
Bilateral subtrochanteric fractures are noted. There is marked osteopenia of both femurs and the pelvic bones.
Na+, K+, Cl-: Normal Ca++:13.3 mg/dl (8.5-10.5) PO4--- 12.6mg/dl (15.3-27) S. Creatinine: normal ALT, AST: normal ALP: 200 IU/l (44-147)
The serum parathyroid hormone level is 121 pg/ml (range: 10-65)
A single area of high uptake corresponding to the left superior parathyroid gland is noted.