Endocrine Abstracts

Introduction: Primary hyperparathyroidism is the most common endocrinopathy after diabetes and thyroid diseases. Most often, the diagnosis is made at the asymptomatic stage due to the frequent phosphocalcic assessment objectifying hypercalcemia. Much more rarely, primary hyperparathyroidism is diagnosed at the stage of digestive, renal or bone complications. We report the case of a young patient with a femoral fracture that revealed primary hyperparathyroidism.

Observation: A 31-year-old male patient with a history of a left leg fracture at the age of 23 years, admitted to the endocrinology department for the management of acute hypercalcemia at 145 mg/l discovered during a workup for a femoral fracture following a simple fall at home. A CT scan of the pelvis revealed a displaced complex fracture of the left femoral neck, with multiple lytic bone lesions, involving the pelvic girdle and the left femur with cystic density. A complementary thoracic-abdominal-pelvic CT scan showed multiple thoracic-abdominal-pelvic lytic bone lesions. The etiological workup revealed a profile of primary hyperparathyroidism, with a left inferior parathyroid adenoma on topography. The patient underwent stabilization of the fracture site by nailing, followed by adenomectomy with bone biopsy, which revealed lesions consistent with hyperparathyroidism.

Discussion and Conclusion: Primary hyperparathyroidism is the consequence of excessive and inappropriate production of parathyroid hormone. It is often caused by a single or multiple parathyroid adenoma. Its revelation by fracture is very rare as it is the case in our patient. The associated bone lesions are often fibrocystic osteitis lesions due to the hyperactivity of osteoclasts, observed in hyperparathyroidism. Management is based on consolidation of the fracture and removal of the secretory adenoma. Every practitioner should consider the diagnosis of primary hyperparathyroidism at the stage of bone pain before complications development.