Presentation
Total thyroidectomy more than 20 years earlier due to papillary thyroid cancer. Secondary hypoparathyroidism treated with calcium and vitamin D supplementation since then. Presented with rapidly progressive headache. Subarachnoid bleeding?
Patient Data
Age: 40 years
Gender: Female
From the case:
Chronic secondary hypoparathyroidism
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- Marked calcification of the falx, especially considering the age group.
- Predominantly frontal hyperostosis.
- No other pathological findings (other multiplanar reconstructions and complete stacks not shown).
From the case:
Chronic secondary hypoparathyroidism
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Abdominal US requested due to elevated CRP two days later:
- Both kidneys (only right one shown) demonstrate a striking increase of medullary echogenicity (note partial distal acoustic shadowing).
- Moderately increased reflectivity of the cortex.
- With colour Doppler the medullary pyramids demonstrate a marked, confluous twinkling-phenomenon due to severe calcification.
- Small, simple cortical cysts.
Case Discussion
Severe, premature falcine calcifications and calvarial hyperostosis, as well as advanced medullary nephrocalcinosis resulting from the treatment of chronic hypoparathyroidism (with multiple episodes of significant hypocalcaemia) treated with calcium and vitamin D supplementation.
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