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Background: Localization of ectopic parathyroid glands is one of the most sophisticated challenges in endocrine surgery and there is considerable controversy regarding the suitable approach to localize ectopic parathyroid glands and indications for using different modalities. The failure of the first operation leads to pain, scar, and financial burden of the following operation. Case: The patient was a 39-year-old woman hospitalized with hematuria as the main complaint and noticing the presentation of hypercalcemia in the initial tests underwent more thorough examination. Ultrasonography and 99mTc sestamibi scan helped us to localize the ectopic parathyroid gland in an anterior mediastinum and treat the patient in a one stage operation. Conclusion: Paying careful attention to the symptoms and signs, considering all differential diagnoses, and using appropriate diagnostic methods can be helpful in the diagnosis of rare syndromes.

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Background: Acute pancreatitis is a common cause of abdominal pain, without any characteristic signs, symptoms, or a gold standard diagnostic modality. The purpose of this study was to evaluate the diagnostic value of urine trypsinogen-2 strip test in acute pancreatitis. Materials and Methods: In this cross-sectional study, 76 patients with abdominal pain suspected to acute pancreatitis who were admitted to the Emergency ward of Valiasr Hospital, Arak, were evaluated. In 46 patients, acute pancreatitis was confirmed (pancreatitis group), whereas in 28 patients, acute pancreatitis was ruled out (control group). In both groups serum levels of amylase, lipase, CRP, and urine trypsinogen-2 were measured by quantitative and qualitative methods. Sensitivity and specificity of the tests were determined and data were analyzed using SPSS software. Results: Urine trypsinogen-2 dipstick was positive in 36 of the 45 patients in the pancreatitis group (sensitivity: 80%) and in 2 of the 28 patients in the control group (specificity: 92.8%). Urine trypsinogen-2 ELISA test was positive in 41 of the 45 patients in the pancreatitis group (sensitivity: 91.1%) and in 4 of the 28 patients in the control group (specificity: 89%). Amylase sensitivity and specificity were equal to 82.6% and 75%, respectively. Lipase sensitivity and specificity were 76% and 85.7%, respectively. Conclusion: Urine trypsinogen-2 dipstick can be used to differentiate acute pancreatitis from other causes of abdominal pain. This rapid, easy-to-use, and accurate test can be used in emergency wards and primary health care units with limited diagnostic facilities.