Hammers and nails: a report

A case report where parathyroid bone disease simulates bone metastases. Subsequent treatment of underlying hyperparathyroidism causes a marked improvement in bone disease, leading to a review of the initial diagnosis. Palliative Medicine 2004; 18: 734-736 Key words: bone metastases; hyperparathyroidism; osteitis fibrosa Case report A 77-year old woman was referred to specialist palliative care. Six years previously, she had had a diagnosis of primary renal carcinoma, which was inoperable, and treated with radiotherapy. At this time there was no evidence of metastatic disease or local disease progression. Although she remained asymptomatic for many years, increasing pain led to a suspicion of bone metastases, secondary to primary renal carcinoma. Findings of a subsequent bone scan (Figures I and 2) were in keeping with this diagnosis although no bone biopsies were performed. Oncology review at this time concluded that the pace of the disease was slow, due to previous high dose radiotherapy at time of diagnosis