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A patient of primary hyperparathyroidism with full-blown bone changes simulating malignancy

T C Chuang1, J M Chang, S J Hwang

  • 1Department of Medicine, Ping-Tung Provincial Hospital, Republic of China.

The Kaohsiung Journal of Medical Sciences
|October 31, 1998
PubMed
Summary

Primary hyperparathyroidism (1 degree HPT) can cause severe bone lesions mimicking malignancy. This case highlights unusual skeletal manifestations and diagnostic clues for 1 degree HPT.

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Area of Science:

  • Endocrinology
  • Oncology
  • Radiology

Background:

  • Hypercalcemia is commonly caused by malignancy or primary hyperparathyroidism (1 degree HPT).
  • Radiographic and histological findings are crucial for differentiating these conditions.
  • Unusual bone manifestations can complicate the diagnosis of hypercalcemia.

Observation:

  • A 43-year-old woman presented with femoral fracture, osteolytic cystic lesions with sclerotic rims, anemia, renal impairment, and hypercalcemia.
  • Extensive osteolytic lesions were noted in the skull and forearms.
  • Malignancy was suspected but ruled out by bone biopsy and serum protein electrophoresis.

Findings:

  • The patient was diagnosed with primary hyperparathyroidism (1 degree HPT) based on elevated parathyroid hormone levels and classic bone pathology (brown tumors).

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  • Nephrocalcinosis was observed on abdominal sonography.
  • A parathyroid tumor was localized and confirmed.

    • Implications:

    • This case underscores the importance of considering primary hyperparathyroidism (1 degree HPT) in patients with hypercalcemia and extensive osteolytic bone lesions.
    • The presence of sclerotic rims in osteolytic lesions may suggest 1 degree HPT over malignancy.
    • Recognizing these rare but full-blown skeletal changes is vital for accurate diagnosis and management.