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PRIMARY HYPERPARATHYROIDISM PRESENTING AS MULTIPLE PATHOLOGICAL FRACTUTES

DINESHKUMAR S

Abstract


Primary hyperparathyroidism often was not   diagnosed until patients develop symptoms and signs of  advanced disease. The prevalence rate varies from 1 to 4 percentage. Elevated PTH levels cause bone resorption, formation of polyostotic lesions and reduction in bone mineral density predisposing to pathological fractures. We had a case of primary hyperparathyroidism with fracture neck of humerus, fracture neck of femur and supracodylar fracture femur  following trivial trauma. The patient also had left superior parathyroid adenoma with elevated parathyroid hormone and alkaline phosphatase. She was treated with percutaneous screw fixation for neck of humerus fracture and neck of femur fracture with plating for supracondylar femur fracture.                 Enucleation of left superior parathyroid adenoma was done followed by calcium and vitamin D supplementation. During follow up period the patient had good fracture union,  improvement in bone density and good functional outcome .

 


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Henry,J.Mankin.: An instruction course lecture - Metabolic bone disease. The American Academy of orthopaedic surgeons. Journal of Bone & Joint Surgery; 1994;Vol- 76A, No.5; 760-788.

Chalmers J, Irvine GB: Fractures of the femoral neck in elderly patients with hyperparathyroidism. Clin Orthop Related Res. 1988 Apr;(229): 125-130

R.G.Deshmukh., S.A.L.Alsagoff., S.Krishnan et al. Primary hyperparathyroidism presenting with pathological fracture. The Royal College of Surgeons of Edinburgh, December 1998; Vol-43, 424- 427.

Lancourt JE, Hochberg F. Delayed fracture healing in primary hyperparathyroidism Clin OrthoP 1977; 124: 214-218Nussbaum,S.R., & Polt,J.T., Jr.: Immunoassays for parathyroid hormone 1-84 in the diagnosis of hyperparathyroidism. J Bone and Min. Res., 6 (supplement 2); s43- s50, 1991.

George,D.C., Incaro,S.J., Devlin,J.T et al .: Histology of bone after parathyroid adenectomy – A case report. J Bone & Joint Surgery .1990;Vol 72A, No: 10 ; pp 1558- 1561.

Satava,R.M., Jr., Beahrs, O.H., and Scholz, D.A.: Success rate of cervical exploration for hyperparathyroidism. Arch.Surg., 1975;Vol-110. 625-628.

Rosenberg AE. Bones, joints, and soft tissue tumors. In: Kumar V, Abbas AK, Aster JC, Fauto N, eds. Robbins and Cotran Pathologic Basis of Disease, 8th ed. Philadelphia, PA: Saunders; 2009:12051256.

Guerrouani A, Rzin A, El Khatib KE. Hyperparathyroidismjaw tumor syndrome detected by aggressive generalized osteitis fibrosa cystica. Clin Cases Miner Bone Metab. 2013; 10(1):65-67.

Fineman I, Johnson JP, Di-Patre PL, Sandhu H. Chronic renal failure causing brown tumors and myelopathy: case report and review of pathophysiology and treatment. J Neurosurg.1999; 90(2 suppl):242-246.

Artul S, Bowirrat A, Yassin M, Armaly Z. Maxillary and frontal bone simultaneously involved in brown tumor due to secondary hyperparathyroidism in hemodialysis patient. Case Rep Oncol Med. 2013; 2013:909150.

Hyan Lee J, Chung S, Su Kim H. Osteitis fibrosa cystica mistaken for malignant disease. Clin Exp Otorhinolaryngol. 2013; 6(2):110-113.

Valera AC, de la Fuenta CM, Buesa AM, Rodriguez SR, Bravo AT, Blasco DH. Osteitis fibrosa cystica as the initial manifestation of primary hyperparathyroidism. Endocrinol Nutr. 2009; 56:140- 142.

Demay MB, Rosenthal DI, Deshpande V. Case 16-2008: a 46-year-old woman with bone pain. N Engl J Med. 2008; 358:2266-2274.

Atabek M, Pirgon O, Sert A, Esen HH. Extensive brown tumors caused by parathyroid adenoma in an adolescent patient. Eur J Pediatr. 2008; 167(1):117-119.

Hoshi M, Takami M, Kajikawa M, et al. A case of multiple skeletal lesions of brown tumors, mimicking carcinoma metastases. Arch Orthop Trauma Surg. 2008; 128(2):149-154


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