The CT of the head demonstrated dense calcifications of the dura along the bilateral cerebral convexities, falx, and tentorial leaflets concerning for hyperparathyroidism. Excess secretion of parathyroid hormone leads to hypercalcemia through increased bone resorption, increased intestinal absorption, and decreased urinary excretion of calcium. It is frequently diagnosed after the fifth decade of life by asymptomatic lab abnormality with common clinical manifestations being renal stones and decreased bone mineral density [1]. The presence of cerebral calcifications as a sequela of hyperparathyroidism is rare. The differential diagnosis includes vitamin D intoxication, Gorlin syndrome (nevoid basal cell carcinoma syndrome), hypertelorism, Maroteaux type brachyolmia, myotonic dystrophy, renal failure, and malignancy [2]. This patient’s age also raised suspicion for Gorlin syndrome as 90% of patients have ectopic calcification by age of 30 years [3].

Based upon the CT, we sent a parathyroid hormone level, which was 214 pg/mL (normal range, 10–55 pg/mL). She had no history of basal cell carcinoma, so Gorlin syndrome was deemed less likely. She was diagnosed with hyperparathyroidism and referred to endocrinology for further management with a plan for parathyroidectomy. This case highlights the importance of clinicians’ awareness of diffuse dural calcifications as an incidental finding that requires referral for endocrinologic evaluation.