Know Your Hormones

Question:    A 45 year old female is referred to you for primary hyperparathyroidism with PTH of 120 and serum Ca of 10.8.  Technetium scan reveals a parathyroid adenoma.  You perform a minimally-invasive procedure, identify the adenoma, and resect it.  Intraoperative and postoperative PTH after the adenoma is removed is in the normal range.  On the first postoperative day, the patient becomes hypocalcemic and exhibits carpopedal spasms.  Oral calcium and vitamin D supplementation is initiated but the patient remains hypocalcemic in spite of normal PTH.  What is your diagnosis?  [Answer will be posted with next week's new question]

Answer to last week's question, Mind the Gap (December 7, 2015): 

Obtain a CT.  The "failed" stapes procedure was likely a perilymph gusher resulting in a dead ear, and given the male sex of both patients, it is important to rule out X-linked stapes gusher syndrome.