Hyperparathyroidism, Primary

Fragile

Step 1: View clinicals

A 47 year old lady is brought in after she slipped and fell on the ground. She was unable to get up due to severe pain in both hips. Close questioning reveals the presence of nocturia and constipation for several months. Her medical history is unremarkable and she is not on any drugs.


Step 2: Order all relevant investigations

X-Ray B/L lower limbs

Bilateral subtrochanteric fractures are noted. There is marked osteopenia of both femurs and the pelvic bones.

Biochemical profile

Na+, K+, Cl-: Normal Ca++:13.3 mg/dl (8.5-10.5) PO4--- 12.6mg/dl (15.3-27) S. Creatinine: normal ALT, AST: normal ALP: 200 IU/l (44-147)

Serum PTH

The serum parathyroid hormone level is 121 pg/ml (range: 10-65)

Tc99 isotope scan

A single area of high uptake corresponding to the left superior parathyroid gland is noted.


Step 3: Select appropriate management

Parathyroidectomy
Bilateral hip screws
Bisphosphonates
Tamoxifen


Score: ★★☆