Parathyroid Adenoma with Unusual Presentations of Rib Bone and Thoracic Vertebrae Fractures in a Premenopausal Female in Ibadan, Nigeria

A Case of Parathyroid Adenoma with Bilateral Subtrochanteric Pathological Femur Fracture - A Rare Case Report

Introduction

Primary hyperparathyroidism is a commonly occurring endocrine disorder that is characterized by elevated calcium levels, decreased phosphate levels, and high levels of parathyroid hormone (PTH). The condition can lead to significant bone resorption and pathological fractures.

Case Report

We report a case of a 44-year-old female who presented with bilateral thigh pain after a trivial fall at home. Radiological investigations revealed a subtrochanteric fracture of the bilateral femur that was deemed pathological. Biochemical testing indicated severe hypercalcemia and hypophosphatemia with elevated levels of serum PTH and an increased alkaline phosphatase level. Ultrasound and computed tomography scans confirmed a parathyroid adenoma, which was treated through excision and histopathological examination. The patient underwent orthopedic intervention for bilateral subtrochanteric femur fracture, and follow-up investigations showed normal biochemical markers and fracture union within 6 months.

Conclusion

Primary hyperparathyroidism should be kept in mind when dealing with bone lesions connected to hypercalcemia, even in asymptomatic individuals and individuals presenting with a trivial mode of trauma. The diagnosis of parathyroid adenoma requires a combination of radiological and biochemical investigations, and a multidisciplinary approach is recommended for the best possible outcome.

Parathyroid Adenoma with a Pathological Fracture: A Rare Case Report

Introduction

Primary hyperparathyroidism may mimic osteoporosis and lead to pathological fractures.

Case Report

We report a case of 35-year-old female who sustained left distal tibia-fibula fracture after a trivial fall, later diagnosed to have left inferior parathyroid adenoma. The fracture was managed conservatively and left inferior parathyroidectomy for the adenoma. At 4 years follow-up, there are no clinical or biochemical signs of recurrence.

Conclusion

Pathological fracture in a case of parathyroid adenoma is extremely rare and requires a multidisciplinary approach for optimal outcome. A combination of clinical, biological, radiological, and biochemical markers with a high index of suspicion in an isolated bone fracture is required to diagnose parathyroid adenoma.