Hypercalcaemia with a negative sestamibi scan
History
58-year-old woman with primary hyperparathyroidism: adjusted calcium 2.78 mmol/L, PTH 11.2 pmol/L, normal renal function, a previous renal stone and forearm osteoporosis. Neck ultrasound by an experienced sonographer found no convincing parathyroid lesion. The endocrine surgeon requests localisation before a focused (minimally invasive) parathyroidectomy.
Step 1 · Dual-phase sestamibi
Neither the 10-min nor the 2-h image shows a focus of retained tracer, and delayed SPECT/CT is also negative. What should be recommended next?