title: Bilateral femoral fractures in a 21-year-old man following a simple fall.
abstract: We present a case of a 21-year-old man with hip pain to the orthopaedic team. During the initial assessment he was found to be hypercalcaemic (adjusted calcium 3.55) due to the primary hyperparathoidism (PTH 1285), with all other screening for multiple endocrine neoplasia negative. During his time on the ward while being treated for the hypercalcaemia he had a fall resulting in bilateral femoral fractures, requiring surgical management. He underwent an emergency exploration of neck and excision of a large parathyroid adenoma, measuring 5.5 cm. He also developed renal failure as a result of nephrocalcinosis. This case highlights the importance of early detection and management of hyperparathyroidism with the aim of preventing long-term complications. This patient ultimately required a renal transplant and multiple orthopaedic procedures as a result of undiagnosed PTH and recently underwent excision of the remaining parathyroid glands.
authors.affiliation: North Tees and Hartlepool NHS trust, Durham, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: French
authors.forename: Deyana
authors.initials: D
authors.lastname: Oweis
authors.forename: Vijay
authors.initials: V
authors.lastname: Kurup
mesh_terms: D000058:Accidental Falls; D000236:Adenoma / Q000150:complications*; D005264:Femoral Fractures / Q000209:etiology*; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology*; D049950:Hyperparathyroidism, Primary / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000209:etiology*; D008297:Male; D009397:Nephrocalcinosis / Q000209:etiology*; D010282:Parathyroid Neoplasms / Q000150:complications*; D055815:Young Adult