Diagnosis of parathyroid adenoma through telemedicine-a unique case report

A 44-year-old male patient presented to an internal medicine consultant over telemedicine through video consultation in July 2021 with gradual onset moderate generalised fatigue and acute body aches since 1 week. On further history it is known that the patient has no comorbidities, with significant family history of diabetes and hypertension in both his parents and that he recovered from mild COVID 19 infection 1 month back in home isolation. On general physical and systemic examination there was no abnormality detected. All his vital parameters were under normal limits. The patient was advised routine complete blood work in order to rule out any post covid complications. Investigations revealed that his serum calcium levels (13.9 mg/dl), and vitamin d levels(129 ng/ml) were high and Hba1c(6.3%) was in prediabetic range. There was no family history of hypercalcemia nor there was any history of renal calculi or fractures.
He was advised further investigations such as intact serum PTH (parathyroid hormone), ultrasound neck and was also asked to repeat serum calcium. Intact serum PTH(179 pg/ml) and serum calcium levels were found to be elevated and ultrasound neck revealed well defined elongated hypoechoic lesion measuring 9*6*5 mm adjacent to the right lobe of thyroid gland postero superiorly with a suspicious vascular pedicle suggesting parathyroid adenoma. To establish and confirm the diagnosis nuclear medicine TcSestamibi parathyroid scan and fine needle aspiration cytology (FNAC) were advised, which confirmed primary hyperparathyroidism secondary to parathyroid adenoma with hypercalcemia and hypervitaminosis D. The patient was counselled and surgerywasadvised for parathyroid adenoma. He underwent parathyroidectomy in July 2021 and he is hemodynamically stable with no complaints