Tag Archive for: Primary Hyperparathroidism PHPT

A Neglected Case of Bilateral Hip Fractures and Other Fractures with Delayed Diagnosis of Hyperparathyroidism as Cause

Vol 4 | Issue 1 | May – Aug 2018 | page: 38-41 | Sanjay Chhawra, Arun Kumar N Kambar, Ravi Gupta


Author: Sanjay Chhawra [1], Arun Kumar N Kambar [1], Ravi Gupta [1].

[1] Department of Orthopaedics, Jaipur Golden Hospital , 2 Institutional Area ,Sec 3 Rohini Delhi 110085.

Address of Correspondence
Dr. Sanjay Chhawra
A-144 Gaytri Vihar Bagh Mughaliya, Bhopal. MP. India.
E-mail: sanjaychhawra@yahoo.com


Introduction: Primary hyperparathyroidism is a disease characterized by hypercalcemia attributable to autonomous overproduction of PTH ParaThyroid Hormone.Primary hyperparathyroidism PHPT is prevalent in approximately 1% of adult population with F;M 3;1. The disease affects multiple systems –Musculosketal, CVS, G.Urinary, Abdomen and Endocrine. Primary hyperparathyroidism present with classic signs and symptoms of hypercalcaemia. Non-specific symptoms may include muscle weakness, thirst, polyuria, anorexia and weight loss along with pathological fractures.The treatment of choice is parathroidectomy after proper investigation.
Case Report: A 40 yrs Male presented with Pain, Swelling and Deformity over Bilateral Hip, Right Shoulder, Right Hand and Right Clavicular Region. Unable to bear weight since 1 year. Along with its General Complaint of Weakness, Joint Pain, Abdominal Pain with clinical syptoms and operated right sided hip after proper investigation patient was diagnosed Hyperparathyridism with B/L Hip fracture {unusual presentation }multiple fractures with implant failure .After Parathyroidectomy and regular follow fracture fixation was done later with calcium supplementation the outcome was satisfactory.
Conclusions: Repeatedly multiple fractures must be investigated with appropriate and precise routine serum biochemical along with PTH Vitamin D Thyroid profile to diagnose endocrine disorder as in this case diagnosed as Hyperparathyroidism.With Clinical examination of neck as specific site with extremities, deformities and systemic examination is essential. USG Neck as routine investigation for this disease. After parathyroidectomy and regular follow up is done. Afterwards fracture fixation is done as secondary procedure with adequate calcium and vitamin D correction give good prognosis better union with best possible outcome. This is rare presentation of PHPT with B/L Hip fracture and other fractures deformities is an excellent example of an endocrine disease that is best managed by a multidisciplinary approach and long term patient follow up.
Keywords: Primary Hyperparathroidism PHPT, Pathological fracture, PTH Parathyroid Hormone.


1. Goode A. W. The parathyroid and adrenal glands. In: Russel R. C.G, Williams N. S and Bulstrode C. J. K (eds). Short textbook of surgery. Arnold, London. 2000; 734-748.
2. Mungadi IA, Amole *AO, Pindiga UH. Primary hyperparathyroidismpresenting with multiple pathological fractures and normocalcaemia.Ann Afr Med 2004;3(1):42e4.
3. Grégoire C, Soussan M, Dumuis ML, Martin A, et al. (2012) Contribution of multimodality imaging for positive and aetiological diagnosis of multiple brown tumours. Ann Endocrinol (Paris) 73: 43-50.
4. Morgan G, Ganapathi M, Afzal S, Grant A.J (2002) Pathological fractures in primary hyperparathyroidism: a case report highlighting diagnostic difficulties. Injury 33: 288-289.
5. Callender GG, Udelsman R. Surgery for pri-mary hyperparathyroidism. Cancer 2014; 120: 3602-3616.
6. John P, Bilezikian MD, Shonni J, Silverberg MD. Asymptomaticprimary hyperparathyroidism. N Engl JMed 2004;350:1746e51.
7. K. A˘gbaht, A. Aytac¸, and S. G¨ull¨u, “Catastrophic bone deformities associated with primary hyperparathyroidism in a middleaged man,” The Journal of Clinical Endocrinology &Metabolism, vol. 98, no. 9, pp. 3529–3531, 2013
8. Henry,J.Mankin.: An instruction course lecture- Metabolic bone disease. The American Academy of orthopaedic surgeons. Journal of Bone & Joint Surgery; 1994;Vol- 76A, No.5; 760-788
9. Albright F, Aub JC, Bauer W (1934) Hyperparathyroidism, a commonand polymorphic condition as illustrated by seventeen proved casesfrom one clinic. JAMA 102:1276-1287.
10. Nussbaum,S.R., & Polt,J.T., Jr.: Immunoassays for parathyroid hormone 1-84 in the diagnosis of hyperparathyroidism. J Bone and Min. Res., 6 (supplement 2); s43- s50, 1991.
11. Lancourt JE, Hochberg F. Delayed fracture healing in primary hyperparathyroidism Clin OrthoP 1977; 124: 214-218
12. A.Khan and J. P. Bilezikian, “Primary hyperparathyroidism: pathophysiology and impact on bone,” Canadian Medical Association Journal, vol. 163, no. 2, pp. 184–187, 2000.
13. Winzelberg G.G ;Parathyroid imaging. Ann.Intern.Med. 1987;vol -107;64-70
14. Lorberboym M, Ezri T, Schachter PP. Preoperative technetium Tc 99m sestamibi SPECT imaging in the management of primary hyperparathyroidism in patients with concomitant multinodular goiter. Arch Surg 2005 Jul;140(7):656e60.
15. Lars Rolighed, MD,1 Lars Rejnmark, PhD, DMSci2 and Peer Christiansen, DMSci Bone Involvement in Primary Hyperparathyroidism and Changes After Parathyroidectomy US Endocrinology 2013;9(2):181–4 3
16. Cristina Stefan1,2, Amalia Arhire1, Luminita Cima1,3 & Carmen Barbu1,3 Long standing primary hyperparathyroidism consequences after parathyroid surgery: fast recovery not only for bone mass Endocrine Abstracts (2017) 49 Ep262 .

How to Cite this article:  Chhawra S, Kambar AN, Gupta R. A Neglected Case of Bilateral Hip Fractures and Other Fractures with Delayed Diagnosis of Hyperparathyroidism as Cause. Trauma International May – Aug 2018;5(1):38-41.

(Abstract Text HTML)   (Download PDF)