A Case of Primary Hyperparathyroidism with Pathologic Fracture, Osteitis Fibrosa Cystica and Hungry Bone Syndrome, Recovered after Parathyroidectomy

Abstract

Severe parathyroid bone disease is a rare clinical presentation of primary hyperparathyroidism. Nowadays primary hyperparathyroidism is diagnosed in an early phase mainly due to the routine use of multi-channel chemical blood screening. We experienced a case of 34 year-old male with primary hyperparathyroidism presenting with pathological femur neck fracture. The patient was presented with fracture of the right femur neck after slip down, and was diagnosed as having primary hyperparathyroidism. Ultrasonography and Tc-99m sestamibi scan revealed an enlarged left inferior parathyroid gland. Tumor was operated and pathologically confirmed to be a parathyroid adenoma. A few days after operation, he developed tingling sensation of perioral area and both hands, which was found to be due to hungry bone syndrome. Calcium, vitamin D, and magnesium supplements were administered. Long term follow-up of blood chemistry revealed recovery of biochemical markers including alkaline phosphatase, calcium, phosphorous, and magnesium. After 9 months, CT (computed tomography) of the pelvis showed decreased porosity and cystic lesions around the femur, and DXA (dual-energy X-ray absorptiometry) revealed markedly increased bone mineral densities in the spine and femur compared with preoperative data.