Endocrine Abstracts

Female patient named M.F., aged 37 years was complaining of Dull aching pain in her left shoulder, difficulty on lifting the left arm into right angle.

The patient had past history of generalised body aches.

The patient sought orthopaedic consultation because the pain in her left shoulder became severe.

X Ray on her left shoulder revealed an intamedullary infiltrative lesion in the humerus of ground glass (Mouth eaten) appearance.

MRI of the left shoulder which revealed abnormal infiltrative bone marrow signals.

CT chest and body revealed Bony skeleton marrow infiltration, Left lower lung nodule, Multiple hepatic focal lesions, Splenomegaly (Query Leukemia or Deposits) and Bone marrow biopsy was adviced.

• Laboratory investigations showed normocytic normochromic anaemia Serum Calcium: 7.7 mg/dl and Ionised Calcium 1 mmol/l.
• Bone marrow aspiration biopsy which revealed Hyper-cellular bone marrow with erythroid hyperplasia.
• PET scan revealed Multiple medullary based osteo-sclerotic lesions scattered all over the skeleton.
• Other laboratory investigations Vitamin D level: 7.46 ng/ml.
• Parathormone hormone: 198.9 pg/ml (normal range is 12–72).
• Alkaline phosphatase: 315 U/l.
• Patient underwent Bone marrow trephine biopsy from right superior posterior iliac spine which revealed Fibrovascular Bone marrow, consistent with osteitis fibrosa cystica related to parathyroid hyperfunction and that was the final diagnosis.
• The patient received treatment in the form of: Vitamin D supplements, Calcium supplements, Calcitonin inhalation, Alpha calcidiol.
• The patient received this treatment for 4 months, the pain in left shoulder has improved and the body aches also improved.
• February 2015: Total calcium: 9.5 mg/dl. Actual calcium: 1.30 mmol/l, Vitamin D: 26 ng/ml. Parathormone hormone: 71 pg/ml.
• The most recent X-ray showed improvement and follow up investigations in January 2016 were all normal.
• Conclusion: osteitis fibrosa cystica can present in a similar way as Malignancy clinically and radiologically and Vitamin D level and parathormone can be the only Key to diagnose it.