Endocrine Abstracts

Background: Primary hyperparathyroidism is usually a long evolving disease before the diagnosis, thus patients who are not diagnosed by routine screening tests may have a lot of complications affecting the bone, kidney, bone marrow.

Aim: Pointing out the possibility of fast recovery not only for bone mass.

Material: We present a case of primary hyperparathyroidism, a female patient 66 years old, sent to emergency room, dehydrated, asthenic, with important hip pain, low back pain. Her Ca=14.3 mg/dl, PTH>4000 pg/dl, Hb=8.5 g/dl, CT: osteolotic lesion, pubis and ischium fracture, two osteolithic lesions on the right acetabulum and the S1 vertebra, bone biopsy: perytrabecullar fibrosis, aspects of bone remodeling and normal medullar celularity, DXA T score: total hip -3, L1-L4 -1.8, forearm -4.4. The complication in the moment of diagnostic were: osteoporosis, spontaneous fragility fractures, medular fibrosis with normocytic normochromic anemia.

Results: Surgery was successful with the normalization of blood calcium and PTH. Questions were raised regarding the high level of PTH(neoplasia was taken into account) and also the impact of medular fibrosis the on the prognosis of the patient. After one year BMD was in age range, DXA T score: total hip -1.2, L1-L4 -0.2, forearm -2, anemia have remitted Hb=12.5 g/dl, and maintained during 2 years follow up.

Conclusion: In spite of high level of PTH and dangerous medular fibrosis, our case show surgical recovery of bone mass but also of medular complications.