Journal of medical case reports 2017 12 0911(1) 342 doi 10.1186/s13256-017-1509-7
Primary hyperparathyroidism revealed by a pathological fracture is very uncommon; in the majority of cases the discovery of lytic bone lesions on imaging examinations evokes in the clinician first a neoplastic etiology and a metabolic origin is often omitted. This case report adds to the existing literature as it describes an unusual presentation of primary hyperparathyroidism.
We report a case of a 50-year-old Moroccan man, without any known tumor, who presented a fracture of his left clavicle with multiple osteolytic lesions on computed tomography suggesting bone metastases. However, bone scintigraphy oriented the diagnosis to a metabolic pathology by showing a metabolic bone "super scan" with increased tracer uptake in the left clavicle; parathyroid scintigraphy was able to localize pathological right parathyroid tissue.
Whenever multiple osteolytic lesions are found in a patient without any known tumor, metabolic bone diseases including hyperparathyroidism should be highly considered.