Endocrine Abstracts

A 67-year-old female patient with a more than five-year history of symptomatic treatment of bilateral hip joint arthrosis, lumbar spine spondiloarthrosis as well as progressive hearing impairmen and dizziness was referrred by orthopedic surgeon to the endocrinology ward for diagnostic workup of metabolic bone disease. From the family history it was known that her mother had similar complains by the age of 60, which rapidly led to disability to walk, but she was never properly investigated. Patients plasma calcium (2.24 mmol/l) and phosphorus (1.48 mmol/l) were within the normal range, but parathyroid hormone (1294 U/l, 12.2 pmol/l) and alkaline phosphatase (1294 U/l) were significantly elevated. The skull radiography revealed areas of increased density and fibrous cortical layer, and similar changes were observed in left thigh and pelvic bones, both hip joint surfaces were narrowed, sclerotic and thickened. The skull CT scan indicated that the cause of the bilateral sensoneural hearing loss was a diffuse and uneven hyperostosis leading to compression of the auditory nerves. Magnetic resonance imaging of lumbosacral, lower thoracic vertebrae revealed degenerative spondylarthrosis. All these findings indicated that patient had the Paget’s bone disease. Patient received a high dose vitamin D therapy followed by a single 5-mg dose of intra venous zoledronate injection and long term calcium and vitamin D substitution that led to an increase of the bone mineral density. After 6 months the knee joint replacement with endoprosthesis was performed.

Discussion: Our case report is showing importance of measurement of the alkaline phosphatase within the endocrinological investigation for metabolic bone disease in patients complaining of hearing loss, vertigo and osteoarthritis. Paget’s disease of bone is a chronic disorder of bone remodelling that begins with excessive bone resorption followed by an increase in bone formation. Mostly it manifests in the 5th decade of life and diagnosed in the sixth decade. Disease commonly affects the pelvis and spine, the sacrum, the skull, and the femur. Skull involvement results in headaches, impaired hearing, vertigo and tinnitus.