CASE REPORT OF PRIMARY HYPERPARATHYROIDISM IN A YOUNG PERSON WITH SEVERE BONE DISEASE

INTRODUCTION Woman, 28 years attended in Health Care Unit (HCU) with asthenia, low back pain and bone pain. Reported fractures in left humerus and clavicle, the first one occurred ten years ago and the last one recently, all low-impact. Reported thyroid surgery. With these symptoms was raised primary hyperparathyroidism hypothesis, an hypercalcemic disorder resulting from excessive secretion of PTH. OBJECTIVE Report a case of a patient presenting at HCU complaining of asthenia, back pain and bone pain and some warning signs that lead to the diagnosis of hyperparathyroidism with severe bone disease. METHOD This is a descriptive study based on medical record data. RESULTS PTH:722pg/ml; Calcium 13mg/dl; ionic calcium:6,45mg/dl; Phosphorus:2mg/d; 25(OH)D:17,1ng/ml; urinary calcium:178mg/24h; Alkaline phosphatase:1624U/L; Bone Densitometry: Z-score -4.4 (L1- L4) and -3.4(total hip), Bone scintigraphy: Standard "Super Scan"; Parathyroid scintigraphy: uptake area adjacent to the lower pole of the right thyroid lobe. X-ray: aspect of salt and pepper skull, diffuse osteopenia, brown tumor (proximal femur) and lytic lesions (hip). CONCLUSION Bone pain and low back pain are common complaints in HCU, however, suspected bone disease was due to warning signs as the young age of the patient, asthenia and a history of low-impact fractures. The hypercalcemia finding motivated forward it to specific clinic, which confirmed the diagnosis. In literature review. We found to be rare cases with bone disease so advanced due to parathyroid hyperplasia, being more prevalent adenoma parathyroid. The successful surgical treatment may result in a large increase in bone mass and full recovery of bone health.