title: Skeletal lesions in primary hyperparathyroidism.
abstract: BACKGROUND
  Osteitis fibrosa cystica (OFC), a relatively rare skeletal disorder caused by excess parathyroid hormone, is often misdiagnosed as a neoplasm. A summary of the diagnostic procedures and treatment protocols, especially the indications for orthopedic surgery, is helpful to avoid overtreatment.
  
  
  METHODS
  Eight patients from the Orthopedic Department of Qilu Hospital of Shandong University diagnosed with OFC caused by primary hyperparathyroidism were treated, and the clinical manifestations, biochemical and radiography examination findings, surgeries and prognoses were recorded.
  
  
  RESULTS
  All cases (5 female and 3 male) were admitted to our department with the complaint of bone pain (5/8) or fracture after mild trauma (3/8). Biochemical screening revealed hypercalcemia and high parathyroid hormone of varying levels. Two cases were misdiagnosed as primary bone lesion and metastasis. All cases were treated with parathyroidectomy and experienced spontaneous and progressive regression of the boney disease. Four cases underwent orthopedic surgery. Bone biopsies were necessary to exclude malignant tumors, especially with orthopedic procedures.
  
  
  CONCLUSIONS
  OFC can easily be misdiagnosed in orthopedic patients because of a lack of radiological and histologic specificity. Reaching the correct diagnosis requires a combination of clinical manifestations, routine biochemical screenings, radiographic examinations of bone and parathyroid and bone biopsy. It is generally acknowledged that parathyroidectomy is effective, but orthopedic surgery is sometimes necessary after a correct diagnosis and parathyroidectomy. However, the indications for orthopedic surgery must be strictly controlled to avoid overtreatment.
authors: *Orthopaedic Department, Qilu Hospital of Shandong University, Jinan, China; #Department of Intervention Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences.
authors: Qiang
authors: Q
authors: Yang
authors: Peng
authors: P
authors: Sun
authors: Jianmin
authors: J
authors: Li
authors: Zhiping
authors: Z
authors: Yang
authors: Xin
authors: X
authors: Li
authors: Zhenfeng
authors: Z
authors: Li
authors: Jun
authors: J
authors: Yan
authors: Ka
authors: K
authors: Li
authors: Luqiang
authors: L
authors: Wang
mesh_terms: D000328:Adult; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000473:pathology*; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010002:Osteitis Fibrosa Cystica / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood; D014057:Tomography, X-Ray Computed
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium