Abstract

RUIPEREZ MORENO, María; MINUESA GARCIA, María; GARCIA ATIENZA, Eva María  and  CAMPO GIMENEZ, María del. Osteitis fibrosa cystica in a patient with asymptomatic hypercalcemia. Rev Clin Med Fam [online]. 2019, vol.12, n.2, pp.101-104. ISSN 2386-8201.

Hypercalcemia is a common chance finding in the primary care setting, as well as in emergency services. Low values of calcemia or its gradual establishment usually go clinically unnoticed, so the diagnosis is often incidental in asymptomatic patients. Our main objective in the differential diagnosis of hypercalcemia is to determine the underlying mechanism, knowing that primary hyperparathyroidism (PHPT) together with malignant neoplasms are responsible for up to 90% of the cases; these conditions must be differentiated early to provide the patient with optimal treatment and accurate prognosis. In our work, we present the clinical case of an 87-year-old woman with a history of sustained asymptomatic hypercalcemia, who presents with pain and non-traumatic functional deficit of the left arm. The imaging test showed a left proximal humerus fracture on an altered bone structure with large "punched-out" cystic areas, an entity that is called osteitis fibrosa cystica and that, although rare, is specific to PHPT; in this case, and after completing the study, it was seen that it was due to a parathyroid adenoma, responsible for up to 85% of cases of PHPT. The only definitive treatment, parathyroidectomy, was rejected by the patient. Therefore pharmacological treatment was initiated, presenting a good clinical-analytical evolution. Recommendations for patients who do not undergo parathyroid surgery include annual monitoring of serum calcium concentrations and bone densitometry.

Keywords : Calcium; Hyperparathyrodism, Primary; Parathyroid Neoplasms; Osteitis Fibrosa Cystica.

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