A 65-year-old woman with type 2 diabetes is on hemodialysis for chronic kidney disease. She now presents to the clinic with symptoms of pain in the hands. The symptoms started many months age and are now getting worse. She does not recall any injury to the hands and has not noticed any swelling or redness in the joints.On examination, the joints are normal with no inflammation or tenderness on palpation. There is full range of motion of the fingers and wrists.Lab investigations: calcium (7.2 mg/dL), phosphate (5.5 mg/dL), and PTH level (710 ng/L). (See Figure below) What is the most likely diagnosis?
The diagnosis is secondary hyperparathyroidism as a consequence of the chronic renal disease. Calcium deposits are seen in the periarticular areas of the fourth and fifth metacarpophalangeal, third proximal interphalangeal, and fourth distal interphalangeal joints. There is slight soft tissue swelling, especially of the fourth and fifth metacarpophalangeal joints. Calcification in scleroderma is subcutaneous in location. In gout, if monosodium urate is deposited it could appear as a soft tissue mass.
scleroderma
gout
secondary hyperparathyroidism
pseudogout
Endocrinology