A rare case of metabolic bone disease.
A 26-year-old female overseas student was admitted to hospital with a fracture of her left humerus following minimal trauma. Biochemical abnormalities included hypercalcaemia, hypophosphataemia, raised alkaline phosphatase, raised parathyroid hormone and undetectable 25-hydroxy-vitamin D. Skeletal X-rays revealed multiple osteolytic lesions in the humerus as well as similar lesions in the femora and pelvis. Magnetic resonance imaging of her left shoulder showed a large soft tissue mass in the proximal humerus. Bone biopsy was reported as consistent with a brown tumour of primary hyperparathyroidism and a sestamibi scan confirmed the presence of a parathyroid adenoma. However, the isotope bone scan was reported as showing features typical of fibrous dysplasia involving multiple sites. The patient subsequently fractured her right femoral shaft, and a femoral nail was inserted. Parathyroidectomy was performed at the same time. Postoperatively she exhibited increased calcium and vitamin D requirements. Coexistence of primary hyperparathyroidism and polyostotic fibrous dysplasia is very rare.
Srivastava
Rajeev
R
Department of Biochemical Medicine, Ninewells Hospital & Medical School, Dundee DD1 9SY, Scotland. rajeev.srivastava@nhs.net
Jenkinson
Fiona
F
Murphy
Michael J
MJ
D000328:Adult; D001851:Bone Diseases, Metabolic / Q000175:diagnosis*; D001842:Bone and Bones / Q000378:metabolism / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D005359:Fibrous Dysplasia, Polyostotic / Q000175:diagnosis* / Q000378:metabolism; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging