A 29-year-old male presented with complaints of progressive and diffuse musculoskeletal pain for the past 6 months and proximal muscle weakness for the past 3 months.He had a minimal response to oral cholecalciferol given empirically for presumed vitamin D deficiency.Radiographs of the pelvis and long bones were unremarkable, and bone mineral density assessment was normal.Laboratory investigations revealed: serum calcium 10 mg/dL (8.6-10.2),serum phosphorus 1.9 mg/dL (2.5-4.5),alkaline phosphatase 110 U/L, 25-hydroxy vitamin D 15 ng/mL, intact PTH 42 pg/ mL, and serum creatinine 0.9 mg/dL.He underwent 68 Ga-DOTATATE PET/CT for disease evaluation Fig 1.
Kumar et al. (2026) studied this question.