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Abstract: If there is redness and pain after a fall, it may usually be a fracture, but this fracture may be caused by hyperparathyroidism. In this patient, after visiting the orthopedic department of the hospital due to a fracture after a fall, the examination revealed a brown tumor in the left upper arm, so he went to the endocrinology department for consultation, and the cause was finally clarified as a parathyroid adenoma. After treatment with calcium-lowering therapy and coordinated surgical procedures, the patient’s symptoms gradually improved and he was discharged successfully.
Basic information】Male, 25 years old
Type of disease】 Hyperparathyroidism, parathyroid adenoma
Hospital】The First Affiliated Hospital of Anhui Medical University
Date of Consultation】June 2020
Treatment plan】Medication (sodium chloride injection + salmon calcitonin injection + calcium carbonate D3 chewable tablet (II) + osteopontin soft capsule) + parathyroid adenoma excision surgery
Treatment Period】Hospitalization for 20 days, outpatient review after 1 month
Effectiveness】The condition has been controlled and the blood calcium and other indicators have improved.
I. Initial consultation
Mr. Xu fell accidentally 1 week ago, and the impact was not great at that time, but the subsequent pain in the left upper arm was more serious, accompanied by redness and swelling, and he could not move normally, so he went to our orthopedic department for consultation, and through X-ray observation, he found that there was a fracture line in the left upper arm, but there was also a brown tumor, so the orthopedic doctor asked the patient to go to our department for consultation. After receiving the patient, we reviewed the patient’s X-ray and initially determined that the patient might have hyperparathyroidism and his fracture might be due to parathyroid adenoma, so the patient was admitted to the hospital for the next step of treatment.
II. Treatment history
After admission, the patient’s electrolytes were examined and the results showed a high blood calcium ion concentration of 2.89 mmol/L and a low blood phosphorus ion concentration of 0.58 mmol/L. During the subsequent examination, the patient’s parathyroid hormone was found to be ten times higher than normal, and according to previous experience, the patient probably had a parathyroid adenoma. ECT was performed, and the results showed an abnormal tracer concentration area in the right lobe of the patient’s thyroid and below, which was considered a high-functioning adenoma of the right parathyroid gland. Subsequent ultrasound and enhanced CT of the parathyroid gland were performed, and the results also supported this conclusion. Treatment was prioritized with calcium-lowering therapy, appropriate supplementation of sodium chloride injection to promote drainage, and salmon calcitonin injection. The patient’s blood calcium concentration and electrocardiogram were monitored, and a surgical consultation was requested to remove the parathyroid adenoma surgically. The surgery went smoothly, and the excised material was sent to the pathology department for testing, and the result was parathyroid adenoma.
III. Treatment effect
After scientific evaluation, the patient’s parathyroid adenoma was promptly identified. The patient’s blood calcium level decreased to 1.52 mmol/L. Parathyroid hormone decreased from 1800 pg/mL before surgery to 250 pg/mL, but the patient developed new symptoms, including perioral and extremity numbness, due to the significant decrease in blood calcium. After calming the patient, he was treated with calcium carbonate D3 chewable tablet (II) and osteopontin soft capsule. The patient’s symptoms gradually improved and he was successfully discharged after 20 days, and the patient was instructed to review regularly after 1 month.
IV. Notes
I am glad that after a series of treatment, the patient was able to be discharged successfully. However, as the patient had a fracture, there was a certain activity impairment, which affected the individual’s daily life and often led to anxiety, so more attention was still needed after discharge, mainly including the following points.
1. the patient should ensure sufficient calcium intake during the recovery period, such as more eggs, milk, lean meat, fish and shrimp can be consumed, and appropriate outdoor activities of half an hour per day are recommended.
2. Since this patient’s fracture was caused by hyperparathyroidism, the patient needs to undergo regular follow-up examinations after discharge from the hospital to regularly assess blood calcium, phosphorus and parathyroid hormone levels. If perioral numbness and hand and foot cramps occur, be alert for hypocalcemia and take calcium tablets or active vitamin D routinely.
V. Personal insight
Every bone in the human body is very important, and when a fracture occurs during a bump, it is not all due to violent impact, but may also be due to bone destruction caused by parathyroid adenoma in the classification of hyperparathyroidism. If the cause is not found, even the use of plates and screws will not help the patient. Therefore, fractures caused by endocrine disorders need to be properly recognized and identified, especially in young people, who should be more vigilant. Parathyroid adenoma is a benign tumor, and the patient in this case was more fortunate in that the parathyroid adenoma was detected in time and treated in the right way to avoid further development of bone destruction, and the treatment effect was clear and the bone destruction was suppressed in time, which proves the importance of correct identification of the cause.