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Abstract: A 46-year-old female patient had pain in her right upper extremity for six months, which was persistent and tolerable, and could not be relieved after rest, but was not significantly aggravated after activity. In the past 2 months, the symptoms worsened and did not ease after symptomatic treatment. 20 days ago, severe pain with swelling in the right upper limb appeared without any cause. She was admitted to the hospital and was considered to have hyperparathyroidism and underwent resection of the left lower parathyroid adenoma in the neck.
Basic information】Female, 46 years old
Disease Type】Pathological fracture of right ulna and humerus, hyperparathyroidism
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of Consultation】September 2019
Treatment plan】Cervical left inferior parathyroid adenoma resection + plaster fixation
Treatment Period】10 days of inpatient treatment, 3 months and 1 year of follow-up
Results】The patient’s pain was relieved, the fracture was healed, and the thyroid function was normal
I. Initial consultation
The patient complained of persistent pain in the right upper limb for half a year. Although the pain was tolerable and there was no local fever or bruising, it could not be relieved after rest and was not significantly aggravated after activity. In the past two months, the symptoms worsened, and the X-ray showed that the right ulnar radial fibroplasia was not relieved by symptomatic treatment. 20 days ago, he had persistent and severe pain in the right upper limb without any cause, accompanied by swelling, but the skin temperature was normal, and it could be mildly relieved after rest, but worsened after activity. He came to our hospital for further diagnosis and treatment.
II. Treatment history
After admission, CT showed osteolytic bone destruction of the right upper middle humerus and lower ulna. The film showed multiple osteolytic bone destruction in the rib and iliac bone. Metastatic lesion is possible. Coagulation function was normal; blood count and sedimentation were normal; urine Benzo protein was normal; tumor markers were normal; phosphorus: 0.58 mmol/L; calcium: 2.89 mmol/L; alkaline phosphatase: 1141 U/L (35-100 U/L). Whole-body bone scan showed: diffuse increase in cranial bone metabolism; increased bone metabolism in multiple locations throughout the body; metabolic bone disease was likely. Bone density showed: osteoporosis.
T-score: -3.7. Parathyroid hormone: 1063.0 pg/ml, diagnosed as hyperparathyroidism after consultation with relevant departments. The patient’s symptoms were relieved and the fracture was healed by excision of the left lower parathyroid adenoma in the neck and postoperative plaster fixation of the fracture.
III. Treatment results
The patient underwent left inferior parathyroid adenoma resection in the neck, and the operation was performed carefully without significant complications. After the operation, the fracture was fixed in plaster. The patient’s general condition was good and no other discomfort symptoms appeared. The patient was discharged after 10 days of hospitalization. The patient was instructed to come to the hospital after 3 months to remove the cast. One year after surgery, the fracture had healed, and the functional exercise was strengthened and the thyroid function was normal. The patient and his family were very satisfied that there was no impact on their daily life.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but after discharge, we recommend the patient to have regular follow-up examinations at 1 month, 3 months, 6 months, 1 year and 3 years to pay attention to the thyroid function status and fracture healing. If the fracture does not heal, surgery may be given. Thyroid function status is reviewed regularly with thyroid function and ultrasound. If thyroid function is abnormal or ultrasound shows any abnormality, you can visit our hospital for treatment. We recommend a high-calcium diet and more sunshine in daily life.
V. Personal insight
This patient was a special patient, who was thought to have a fracture caused by a tumor in the local hospital and many other hospitals. After admission, we carefully improved the examination and observed the abnormal indicators, found abnormal thyroid function, gave the correct diagnosis, and the fracture healed spontaneously after subsequent related treatment. It was a blessing for the patient, but if it was a tumor, it would have been a heavy blow to the patient, whereas hyperparathyroidism is easier to accept compared to tumors. The implication for us is that for patients with fractures, we should learn differential diagnosis to reduce misdiagnosis, and also patients with problems should be detected and treated as early as possible.