Pathological subtrochanteric fracture revealing a primary hyperparathyroidism: A case report

• Published in: International journal of surgery case reports 2023-05, Vol.106, p.108158, Article 108158
• Main Authors: Haouzi, M.A., Benbouzid, Y., Baidriss, Y., Kharmaz, M., Zouaidia, F., Sfar, K.
• Format: Article
• Language: English
• Subjects: Brown tumor; Case Report; Cephalomedullary nail; Hyperparathyroidism; Subtrochanteric fracture
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2023.108158

Primary hyperparathyroidism is the third most common endocrine disorder after diabetes and thyroid disease. Nevertheless, a pathological fracture revealing primary hyperparathyroidism is not commonly described. We present the case of a 30-year-old male patient who was admitted with a subtrochanteric pathologic fracture of her left femur after a trivial fall. Due to suspicion of bone metastases, a thoraco-abdomino-pelvic CT scan was requested. It revealed multiple irregular circumscribed lytic bone lesions in the ribs, the right scapula, the dorsal spine, and the pelvic girdle; bilateral renal lithiasis; and a nodule contiguous to the left posterior thyroid lobe. A surgical biopsy of the bone lesion was performed. Histopathological examination confirmed the diagnosis of primary hyperparathyroidism with a brown tumor. Laboratory tests showed increased both calcium and PTH levels. The patient underwent cephalomedullary nail fixation with bipolar locking. After that, a parathyroidectomy was performed. At six months' follow-up, the functional result was satisfactory. Primary hyperparathyroidism is the most common cause of hypercalcemia. It occurs as a result of a parathyroid adenoma in 80 % of cases. Definitive diagnosis should be made by clinical history, radiological findings and confirmed by biochemical tests including serum parathyroid hormone (PTH), alkaline phosphatase, calcium, phosphate, and vitamin D levels. This case report emphasizes the need of including brown tumors in the differential diagnosis of multifocal osteolytic bone lesions, in order to ensure appropriate treatment. •Primary hyperparathyroidism is the third most common endocrine disorder after diabetes and thyroid disease•Pathological fracture revealing a primary hyperparathyroidism is not commonly described.•Pathological fractures due to brown tumors are usually found in severe or neglected cases of hyperparathyroidism•The main treatment of brown tumors is surgical removal of the hyperfunctioning parathyroid gland.