Shamrez Khan, Mohammad Aslam.
Hyperparathyroidism: an unusual presentation.
Pak Armed Forces Med J Jan ;53(1):101-3.

A 32 years old lady reported with 2 1/2 years history of generalized body aches and pains, weakness, pain knee joints along with difficulty in walking. About 2 years ago, she got fracture of left femoral shaft while walking at home. She was operated upon for that fracture in civil hospital Lahore where open reduction with internal fixation was done. During these 2 years, she visited many hospitals in Lahore as her fracture did not unite and because of persistence of her complaints. She was unable to move even with crutches. Her X-ray femur was reviewed by some surgeon because of delayed union during this period. He concluded that the fracture could be pathological and advised bone scan to rule out lytic bony metastases. Bone scan was normal. Her blood chemistry record like serum calcium, phosphate, alkaline phosphatase was not available. For the last few months, she started having pain in right thigh and visited radiology department for X-ray right thigh. This X-ray showed multiloculated cystic lesion in femoral shaft. Keeping in view the old pathological fracture in left femur and fresh appearance of cystic areas in right femur, the radiologist raised the suspicion of brown tumors of HPT, because metastases were already ruled out by bone scan. The lady was advised skeletal survey, ultrasound (US) neck and abdomen, serum, calcium, phosphate, parathyroid hormone, urea and electrolyte studies. X-ray hands showed minimal subperiosteal resorption on radial aspect of phalanges in index and middle fingers. X-ray skull, chest, lumbosacral spine and pelvis were normal. Lab tests of this patient confirmed primary hyperparathyroidism, due to parathyroid gland adenomas.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com