For 2 weeks, a 67-year-old obese woman has had episodes of diffuse, nonradiating abdominal pain that last for several hours and are slightly relieved by famotidine/antacid. She rates the pain as 7 on a scale of 1 to 10. She also has had nausea without vomiting and infrequent dyspepsia/heartburn; the nausea does not worsen with meals. She denies other GI symptoms and recent foreign travel; has not eaten food from local street vendors; and has had no fever, chills, night sweats, or sudden change in weight.
The patient has hypertension and osteoporosis and takes hydrochlorothiazide, calcium with vitamin D, and alendronate. She has no history of drug allergies or alcohol, tobacco, or illicit drug use. She has a family history of diabetes.
The patient is afebrile. Blood pressure is 146/78 mm Hg. Frequent eructation is noted during the examination. Heart and lung sounds are normal. The abdomen is distended and tympanic; bowel sounds are present in all 4 quadrants. There is no rebound or guarding. No abdominal mass or hepatosplenomegaly is noted. Digital rectal examination reveals no significant masses. A stool sample is negative for occult blood.
Results of a complete blood cell count; chemistry panel; liver function tests; measurement of serum amylase, lipase, albumin, and total protein; examination of stool for ova and parasites; and urinalysis are normal. However, the serum total calcium level is 13.1 mg/dL (normal, 8 to 11 mg/dL).
The results of a technetium-99m sestamibi scan are shown here.
To what diagnosis do the clinical findings and scan results point?
- Primary hyperparathyroidism.
- Vitamin D intoxication.
- Addison disease.
(Answer on next page.)
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