Sacroiliitis-like pain as the initial presentation of primary hyperparathyroidism

Hyperparathyroidism often presents with asymptomatic hypercalcemia or minimal, unspecific symptoms and the middle-age female is the predominant population.

We reported a young Vietnamese female with primary hyperparathyroidism presented with chronic low back pain of about 1 year duration, similar to sacroiliitis. An initial study of bone scan raised the suspicion of sacroiliitis. However, careful review of her symptoms and signs did not demonstrate the presence of typical inflammatory low back pain instead of severe osteoporosis and osteitis fibrosa cystica. A computed tomography of pelvis showed subchondral bony resorption or erosive change with bilateral SI joint widening which more favored hyperparathyroidism than sacroiliitis.

This case highlights the point that primary hyperparathyroidism could be presented with sacroiliitis-like pain and severe bone disease in young patient from a developing country.