Cargando…

Multiple Brown tumors in a Case of Primary Hyperparathyroidism with Pathological Fracture in Femur

INTRODUCTION: Pathological fractures in long bones are commonly caused by simple bone cyst or Osteogenesis imperfecta in children and by metastatic tumors from primary carcinoma, multiple myeloma, osteoporosis, and bone tumors in adults. Hyperparathyroidism causing pathological fractures, though a w...

Descripción completa

Detalles Bibliográficos
Autores principales: Dhaniwala, Nareshkumar Satyanarayan, Dhaniwala, Mukund Naresh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Indian Orthopaedic Research Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815671/
https://www.ncbi.nlm.nih.gov/pubmed/33489969
http://dx.doi.org/10.13107/jocr.2020.v10.i06.1872
_version_ 1783638280149925888
author Dhaniwala, Nareshkumar Satyanarayan
Dhaniwala, Mukund Naresh
author_facet Dhaniwala, Nareshkumar Satyanarayan
Dhaniwala, Mukund Naresh
author_sort Dhaniwala, Nareshkumar Satyanarayan
collection PubMed
description INTRODUCTION: Pathological fractures in long bones are commonly caused by simple bone cyst or Osteogenesis imperfecta in children and by metastatic tumors from primary carcinoma, multiple myeloma, osteoporosis, and bone tumors in adults. Hyperparathyroidism causing pathological fractures, though a well-known entity, is seen infrequently in clinical practice. The fractures occur in the expansile fibro-cystic bone lesions called as “Brown tumor.” The reported case describes a patient with classical features of primary hyperparathyroidism (PHPT) having multiple lytic lesions in pelvis and bilateral femur with pathological fracture. It is being reported due to its rarity. CASE REPORT: A 28–year-old young married lady presented with chronic dull aching pain in both thighs and difficulty in walking for 2 years. Examination revealed tenderness in both thighs, with antalgic gait. X-ray pelvis with both thighs showed multiple lytic lesions of variable size in both femora and pelvis. Blood investigations showed raised levels of serum calcium, with highly raised levels of serum parathyroid hormone (PTH). Contrast-enhanced computerized tomography (CT) scan of neck demonstrated parathyroid adenoma. The patient admitted for prophylactic nailing for right femur, developed a fracture while indoor and was managed by right proximal femoral nailing, followed by parathyroid adenoma excision. Follow-up showed dramatic clinical and radiological improvement with good healing of fracture. Lytic lesions healed gradually and blood parameters returned to normal. The patient remains asymptomatic at 2 years follow-up. CONCLUSION: Advanced case of symptomatic PHPT affecting bones is rare and it should be considered as a differential diagnosis in cases of a solitary and or multiple osteolytic lesions. Serum calcium and PTH level estimation at an early stage prevents missing the diagnosis and progression of disease. Early diagnosis and appropriate treatment help in rapid clinical improvement with almost total reversal of bony changes, thus avoiding devastating complications.
format Online
Article
Text
id pubmed-7815671
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Indian Orthopaedic Research Group
record_format MEDLINE/PubMed
spelling pubmed-78156712021-01-21 Multiple Brown tumors in a Case of Primary Hyperparathyroidism with Pathological Fracture in Femur Dhaniwala, Nareshkumar Satyanarayan Dhaniwala, Mukund Naresh J Orthop Case Rep Case Report INTRODUCTION: Pathological fractures in long bones are commonly caused by simple bone cyst or Osteogenesis imperfecta in children and by metastatic tumors from primary carcinoma, multiple myeloma, osteoporosis, and bone tumors in adults. Hyperparathyroidism causing pathological fractures, though a well-known entity, is seen infrequently in clinical practice. The fractures occur in the expansile fibro-cystic bone lesions called as “Brown tumor.” The reported case describes a patient with classical features of primary hyperparathyroidism (PHPT) having multiple lytic lesions in pelvis and bilateral femur with pathological fracture. It is being reported due to its rarity. CASE REPORT: A 28–year-old young married lady presented with chronic dull aching pain in both thighs and difficulty in walking for 2 years. Examination revealed tenderness in both thighs, with antalgic gait. X-ray pelvis with both thighs showed multiple lytic lesions of variable size in both femora and pelvis. Blood investigations showed raised levels of serum calcium, with highly raised levels of serum parathyroid hormone (PTH). Contrast-enhanced computerized tomography (CT) scan of neck demonstrated parathyroid adenoma. The patient admitted for prophylactic nailing for right femur, developed a fracture while indoor and was managed by right proximal femoral nailing, followed by parathyroid adenoma excision. Follow-up showed dramatic clinical and radiological improvement with good healing of fracture. Lytic lesions healed gradually and blood parameters returned to normal. The patient remains asymptomatic at 2 years follow-up. CONCLUSION: Advanced case of symptomatic PHPT affecting bones is rare and it should be considered as a differential diagnosis in cases of a solitary and or multiple osteolytic lesions. Serum calcium and PTH level estimation at an early stage prevents missing the diagnosis and progression of disease. Early diagnosis and appropriate treatment help in rapid clinical improvement with almost total reversal of bony changes, thus avoiding devastating complications. Indian Orthopaedic Research Group 2020-09 /pmc/articles/PMC7815671/ /pubmed/33489969 http://dx.doi.org/10.13107/jocr.2020.v10.i06.1872 Text en Copyright: © Indian Orthopaedic Research Group http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Dhaniwala, Nareshkumar Satyanarayan
Dhaniwala, Mukund Naresh
Multiple Brown tumors in a Case of Primary Hyperparathyroidism with Pathological Fracture in Femur
title Multiple Brown tumors in a Case of Primary Hyperparathyroidism with Pathological Fracture in Femur
title_full Multiple Brown tumors in a Case of Primary Hyperparathyroidism with Pathological Fracture in Femur
title_fullStr Multiple Brown tumors in a Case of Primary Hyperparathyroidism with Pathological Fracture in Femur
title_full_unstemmed Multiple Brown tumors in a Case of Primary Hyperparathyroidism with Pathological Fracture in Femur
title_short Multiple Brown tumors in a Case of Primary Hyperparathyroidism with Pathological Fracture in Femur
title_sort multiple brown tumors in a case of primary hyperparathyroidism with pathological fracture in femur
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815671/
https://www.ncbi.nlm.nih.gov/pubmed/33489969
http://dx.doi.org/10.13107/jocr.2020.v10.i06.1872
work_keys_str_mv AT dhaniwalanareshkumarsatyanarayan multiplebrowntumorsinacaseofprimaryhyperparathyroidismwithpathologicalfractureinfemur
AT dhaniwalamukundnaresh multiplebrowntumorsinacaseofprimaryhyperparathyroidismwithpathologicalfractureinfemur