Images in Clinical Medicine

Massive Calcification in Pseudohypoparathyroidism

Tominaga Shimizu, M.D., and Teiji Takeda, M.D.

N Engl J Med 2003; 349:464July 31, 2003

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Article

A 55-year-old man with a 24-year history of pseudohypoparathyroidism type 2 presented with a mass in the right buttock and reported difficulty walking. At the time of diagnosis, he had had a low serum calcium level (5.2 mg per deciliter [1.3 mmol per liter]) and a high phosphate level (9.1 mg per deciliter [2.9 mmol per liter]) without an increase in urinary phosphate excretion despite normal urinary excretion of cyclic adenosine monophosphate in response to parathyroid hormone. At that time, he was treated with vitamin D, aluminum gel, and calcium carbonate. Subsequently, serum calcium and phosphate levels were well controlled, but chronic renal failure and a gait disturbance developed. On physical examination, a large, hard mass was palpated under the skin around the right buttock, and the range of motion of the patient's hip joint was found to be severely restricted in all directions. Plain-film radiographs showed diffuse calcification around the right hip joint. A history of trauma to the right buttock was the probable explanation of the asymmetric nature of the lesion.

Tominaga Shimizu, M.D.
Teiji Takeda, M.D.
Shinshu University School of Medicine, Matsumoto 390-8621, Japan