A 63-year-old man attended our department reporting a 3-month history of diffuse pain in both hands. He had been investigated for primary hyperparathyroidism because of previous episodes of hypercalcaemia—the last time had necessitated hospitalisation—despite taking high doses of a calcimimetic (cinacalcet). The patient's maximum serum calcium concentration had been 13·3 mg/dL (normal range 8·5–10·5). His parathyroid hormone (286 pg/mL; normal range 12–88) and 24-h urine test for calcium (491·8 mg; normal range 100–300) had also been raised; imaging studies had been inconclusive for parathyroid hyperfunction.
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