Hyperparathyroidism shoulders the blame

These masses on the shoulders of a man in his 40s are the result of bilateral calcification of periarticular soft tissue due to treatment resistant secondary hyperparathyroidism (fig 1). The masses had developed over the preceding seven years, and, although painless, restricted range of motion in the shoulders. Secondary hyperparathyroidism can occur in people with chronic kidney failure—as was the case with this man, who had been receiving renal dialysis for 10 years. Serum biochemistry showed low calcium and 25-hydroxyvitamin D levels and raised alkaline phosphatase and parathyroid hormone levels. The patient subsequently underwent parathyroid radiofrequency ablation, and at two month follow-up the masses had become smaller.bmj;381/may11_4/e073581/F1F1f1Fig 1
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