Diffuse Skeletal [18F]FDG Uptake from Renal Osteodystrophy with Parathyroid Hyperplasia in an ESRD Patient: A Case Report

Articles in Press

Document Type : Case report

Authors

1 Tehran University of Medical Sciences, Nuclear medicine, Tehran, Tehran Province, Iran

2 Tehran University of Medical Sciences, Department of Nuclear Medicine, tehran, Iran

3 Tehran University of Medical Sciences, Tehran, 4Department of Nuclear Medicine, Imam Khomeini Hospital Complex, Tehran, Iran

4 Tehran University of Medical Sciences, Nuclear medicine, Tehrān, Tehran Province, Iran

5 Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences

10.22038/aojnmb.2026.89787.1654

Abstract

Introduction: Secondary and tertiary hyperparathyroidism (HPT) are common complications in patients with end-stage renal disease (ESRD) and may result in renal osteodystrophy. While [18F]-FDG PET/CT is primarily used to evaluate malignancy, it may occasionally reveal metabolic or endocrine abnormalities.

Case presentation: A 45-year-old male with ESRD on hemodialysis presented with generalized bone pain and radiologic suspicion of malignancy. [18F]-FDG PET/CT demonstrated diffusely increased skeletal uptake and multifocal lytic bone lesions, consistent with metabolic bone disease secondary to renal osteodystrophy. Incidental findings of soft tissue nodules in both tracheoesophageal grooves suggested parathyroid pathology. Subsequent [99mTc]Tc-sestamibi SPECT/CT confirmed parathyroid adenomas/ hyperplasia. Laboratory tests revealed elevated calcium (10.8 mg/dL), phosphorus (7.2 mg/dL) and markedly increased parathyroid hormone (3120 pg/mL) levels.

Discussion: This case highlights that diffuse skeletal [18F]-FDG uptake in ESRD may mimic malignancy but actually represent metabolic bone disease due to secondary or tertiary HPT. The [18F]-FDG PET/CT findings of parathyroid lesions were incidental, while [99mTc]Tc-sestamibi SPECT/CT accurately localized the hyperfunctioning glands.

Conclusion: FDG PET/CT can incidentally demonstrate metabolic bone disease and parathyroid-[18F] abnormalities in ESRD, but [99mTc]Tc-sestamibi SPECT/CT remains the preferred modality for parathyroid localization. Awareness of this potential finding may prevent misinterpretation and guide appropriate management.

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Asia Oceania Journal of Nuclear Medicine and Biology

Articles in Press, Accepted Manuscript
Available Online from 21 February 2026

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