Endocrine Abstracts

Introduction: Primary hyperparathyroidism (PHPT) occurs a peak incidence between ages 50 and 60 and the classical bone disease of PHPT or pathological fractures due to PHPT is rarely seen today. Furthermore brown tumor detected with Tc-99m MIBI scintigraphy exists in literature infrequently.

Case: A 23 years old woman presented with left arm pain admitted in Department of Orthopaedics for pathological fracture in left humerus. As a result of investigations hypercalcemia and cystic lesions in diaphysis of left humerus and many other bone localization found, then referred to our section.

Initial laboratory profile, serum calcium: 15.2 mg/dl (8.6–10.2), serum phosphorus: 2.5 mg/dl (2.6–4.5), total alkaline phosphatase: 722 U/l (35–105), 24-h urine calcium: 572 mg/day (100–321), PTH (IRMA): 3308 ng/ml (15–65), 25(OH)vitamin D: 8.98 ng/ml (25–80). Rest blood results revealed normal. Also there was no abnormality at plasma calcitonin, metanephrine, normetanephrine, anterior pituitary hormones and basal cortisol levels.

Neck ultrasound showed an encapsulated, homogeneous, hypoechoic solid mass lesion at inferior pole of right lob of tyhroid gland, largest measures 2×2×1.5 cm in dimension, contains central and peripheral vascularity.

Tc-99m MIBI scintigraphy was performed and a foci of radiotracer accumulation was seen caudal to the right lobe of thyroid gland, also found accumulations on distal third of the left clavicle and the localizations of both sternoclavicular joints consistent with brown tumor.

Evaluation of bone mineral density; the lowest Z-score value in localization lumbar region and total value of the femur were recorded as (−3.2) and (−1.9), respectively.

After seum calcium values lowered the patient was operated and localized parathyroid gland was excised. The pathological evaluation revealed parathyroid adenoma.

Conclusion: PHPT also occurs at a young age therefore familial hyperparathyroidism syndromes such as MEN should be investigated in these cases. Nowadays despite most patients with PHPT do not have the classic radiologic bone disease, the skeleton lesions can be seen and even lead to pathological fractures. Furthermore cystic lesions in bones can be evaluated inaccuracy primary bone tumor.