I've just started my private practice and the local endocrine guys are testing my mettle.
24F, presented with hypercalcemia and elevated PTH (around 60), explored with 4 enlarged glands, 3 removed and one biopsied. Path c/w hyperparathyroidism (no surprise there.) Unfortunately hypercalcemia persisted, with slight elevation in PTH - 35 to 60. Re-explored by a prominent local surgeon - 4th gland excised and transfered to forearm, no other glands identified. Mediastinum explored, nothing in thymus.
Well still has calcium @ 11.5, PTH from 30-50. Urine calcium around 2-300, nothing on workup for MEA, etc.
Peripheral PTH 32 and 34 - i.e., no difference in arm with transplanted tissue.
I was thinking of a Tec99-sestamibi scan. Any other recommendations.