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Multiple Abusive Fractures in an Infant With a Concurrent Parathyroid Hormone-Related Peptide-Secreting Renal Tumor:

Samir S Keblawi1, Jason N Wright, Jeffrey P Otjen

  • 1From the Multicare, Spokane.

Pediatric Emergency Care
|April 12, 2019
PubMed

Insights

Evaluating infants with unexplained fractures requires assessing for underlying bone fragility. A rare tumor secreting parathyroid hormone-related peptide (PTHrP) presented with abuse indicators, not bone insufficiency signs.

Area of Science:

  • Pediatric Endocrinology
  • Pediatric Oncology
  • Forensic Pathology

Background:

  • Child abuse evaluation necessitates identifying underlying bone fragility causes.
  • Differential diagnosis for infant fractures includes metabolic bone diseases and abuse.

Observation:

  • A 7-month-old infant with a mesoblastic nephroma secreting parathyroid hormone-related peptide (PTHrP) presented with hypercalcemia and hypophosphatemia.
  • The infant exhibited multiple fractures, bruising, and classic metaphyseal lesions, inconsistent with bone insufficiency.
  • Radiographic findings were highly suggestive of physical abuse, co-occurring with the hormone-secreting tumor.

Findings:

  • Tumor-induced hyperparathyroidism (hyper PTH) did not manifest as demineralization or typical bone changes.
  • Fracture patterns and bruising strongly indicated inflicted injury rather than bone fragility from hyper PTH.
  • The case highlights the challenge of distinguishing abuse from medical conditions mimicking bone fragility.

Implications:

  • Tumor-related hyperparathyroidism (PTHrP) should be considered in infants with unexplained fractures and bone fragility.
  • Children with medical conditions predisposing to injury may also be victims of abuse.
  • Integrated diagnostic approaches are crucial for accurate assessment in complex pediatric cases.
Abstract

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