Endocrine Abstracts

Background: Primary hyperparathyroidism (PHPT) is a systemic disease caused by lesions of the parathyroid gland, such as parathyroid adenoma, parathyroid hyperplasia, and parathyroid carcinoma. Bone disease is an important complication of hyperparathyroidism. We herein report a rare case of severe bone disease caused by primary hyperparathyroidism.

Case report: A 33-year-old female patient presented with a history of right lower limb pathological fracture, that restricted her mobility. The fracture was first treated surgically, without any medical follow-up. 5 years later, she presented in Emergency department with a severe anemia requiring a blood transfusion. Meanwhile laboratory data showed a hypercalcemia of 129 mg/l with an elevated serum Parathormone (PTH)of 744.3 pg/ml and vitamin D deficiency. Thyroid and multiple endocrine neoplasia (MEN) assessment were normal. X-ray examination showed Multiple osteolytic brown bone tumors disseminated throughout the skeleton. The CT scan demonstrated heterogeneous nodular formation located in the postero-inferior pole of the left thyroid lobe with a mediastinal extension measuring 26×25×47 mm. The patient was finally diagnosed with PHPT. She was prepared pre operatively with isotonic salin hydratation to manage hypercalcemia and vitamin D supplementation to avoid hungry bone syndrom. The patient underwent a surgical excision of the left inferior parathyroid. The surgical exploration of the remaining parathyroid glands was normal. The patient was discharged in good clinical condition. Total serum calcium and parathormone were within the reference range on the second day after surgery. Anatomopathological study in still in progress.

Discussion: PHPT leads to an excessive synthesis and secretion of PTH which causes an enhancement of osteoclasts’ effects and causes Therefore calcium and phosphore in bones to be dissolved into the blood, resulting in hypercalcemia and hyperphosphatemia. Most patients with PHPT are asymptomatic. Very few may present with skeletal system manifestations such as bone pain, osteoporosis and pathological fracture; they may also develop brown tumors and osteitis fibrosa cystica. Most patients are first diagnosed in the department of orthopedics, resulting in a high rate of delayed treatment or misdiagnosis which can lead to further aggravation of pathological bone damage. Once confirmed, timely resection of the diseased parathyroid glands is considered to be the preferred method for the treatment of PHPT with severe bone disease, rather than treatment of the skeletal system disease only. After surgery PTH and other relevant indicators gradually return to normal levels, and new bone tissue gradually grows within and resolves the skeletal lesions.