ECE2015 Eposter Presentations Calcium and Vitamin D metabolism (96 abstracts)
Primary hyperparathyroidism presented as humeral brown tumor and multiple bone fractures
Lia Ferreira , Pedro Gomes , Pedro Cardoso , Vitor Valente , Ana Amado , Maria Teresa Pereira , Susana Garrido , Raquel Almeida , Cláudia Freitas , Cláudia Amaral , Isabel Palma & Fátima Borges
Centro Hospitalar do Porto, Porto, Portugal.
Primary hyperparathyroidism (PHPT) is frequently diagnosed as an incidental finding of hypercalcemia. Overt bone disease (osteitis fibrosa cystica or brown tumor), with history of pathologic fractures is a rare presentation.
A 48-year-old woman was admitted in with pain in the right thigh after a trivial fall. She also complained of generalized weakness and lethargy over the last 2 years. Her medical history mention multiple bone fractures in the last 6 years, namely left patella, both wrists and 4 years before surgery to lytic lesion of the right humerus, assumed as aneurysmal bone cyst. Her last follow-up CT, revealed recurrence of lytic lesion and she was propose to shoulder arthroplasty.
Plain X-rays and CTs revealed pathologic fracture of the right femur, multiple osteolytic lesions (right humerus, right femur, both shoulder blades and iliac bones), subperiosteal erosions in the distal phalanges and old fractures in the ribs. Bone scan showed increased uptakes over the right humerus, right femur and tibias. Femur fracture was managed with osteosynthesis and humeral biopsy documented multiple giant cells consistent with brown tumor of PHPT.
Analysis revealed severe PHPT (serum calcium 3.49 mmol/l, phosphorus 0.53 mmol/l, and PTH 1435 pg/ml). Ultrasound showed an 5.8×3.9×2.4 cm mixed texture lesion in the left superior parathyroid and sestamibi scanning confirmed a left parathyroid adenoma, with a necrotic centre and bone uptakes coincident with previous bone scan.
Considering patient’s age and high level of PTH, chest–abdomen CT were performed to excluded metastatic disease. Hereditary cancer syndromes were also excluded. Treatment was initiated with hydration and zolendronic acid and parathyroidectomy was perform. Histopathology confirmed the diagnosis of parathyroid adenoma. Hungry bone syndrome developed following surgery and was necessary treatment with calcium carbonate and alfacalcidol.
Conclusion: Pathological fractures in young adults should always be investigated. A high index of suspicion is necessary to diagnose this unusual presentation of PHPT.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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