This 50 year old professor of Medicine has recently become quite cantankerous with his students for the past year or so. He complains of pain in his back, legs, and hands but has no clinical evidence of inflammatory arthritis, such as heat and redness are not evident.
His physical exam revealed the following:
Middle aged gentleman with erratic behavior, tenderness on index finger Rt and Lft hands
Augmented peristalsis.
His laboratory studies are summarized:
Hemoglobin 14.7 g%
Hematocrit 48%
WBC 7430 nl diff.
Serum calcium 13 mg/dL (Nl 10.5)
PTH elevated to 3 SI units (Nl =1)
Urine Nl.
Alkaline Phosphatase 7 (nl 1-4 B units)
Thyroid scan Nl.
Hand X-ray shows bony resorption of distal phalange of index finger.
See Fig. 1
Your diagnosis is: