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A 55 year old man has broken the mid shaft of his left humerus while pulling on his lawnmower start cord. An x-ray reveals a pathological fracture on top of a lytic bone lesion. The patient™s bones show fibrosis of the bone along with multiple cystic lesions. The patient states that he has been having a lot of non-specific bone pain recently, been extremely constipated, having crampy abdominal pain, and feeling overly fatigued for the last month. The patient has a history significant for calcium oxalate kidney stones. Which serum profile most accurately matches that of the patient?
A - Increased calcium, increases phosphate, decreased PTH
B - Increased calcium, decreased phosphate, increased PTH
C - Decreased calcium, decreased phosphate, increased PTH
D - Decreased calcium, increased phosphate, normal PTH
E - Normal calcium, normal phosphate, normal PTH
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BBB Primary hyperparathyroidism
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BBBB. When there is constipation, first thing come to my mind in a setting of bone problem, is hypercalcemia.
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yes, its bb: primary hyperparathyroidism
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yep all correct
KNOW THIS FOR THE USMLE: Patients with hyperparathyroidism have moans (bone pain), groans (constipation), stones (kidney stones), bones (bone lesions), and psychic overtones (CNS symptoms).
Explanation: This patient has hyperparathyroidism. Hyperparathyroidism is overactivity of the parathyroid glands resulting in excess production of parathyroid hormone (PTH). The parathyroid hormone regulates and maintains calcium and phosphate levels. Overactivity of one or more of the parathyroid glands causes hypercalcemia and hypophosphatemia. The symptoms of hyperparathyroidism can be remembered by the rhyme "moans, groans, stones, bones, and psychiatric overtones". "Stones" refers to kidney stones which can ultimately lead to renal failure. "Bones" refers to bone-related complications. The classic bone disease in hyperparathyroidism is osteitis fibrosa cystica and osteomalacia with possible sequelae of pain and sometimes pathological fractures. "Abdominal groans" refers to gastrointestinal symptoms of constipation, indigestion, nausea and vomiting. Hypercalcemia can lead to peptic ulcers and acute pancreatitis. "Psychic overtones" refers to effects on the central nervous system. Symptoms include lethargy, fatigue, depression, memory loss, psychosis, ataxia, delirium, and coma.
This patient™s pathological fracture was caused by osteitis fibrosa cystic. Osteitis fibrosa cystica (also known as Von Recklinghausen's disease) is a skeletal disorder caused by a surplus of parathyroid hormone, which stimulates the activity of cells known as osteoclasts that break down bone. Osteoclastic bone resorption releases minerals, including calcium, from the bone into the bloodstream. This process results in a loss of bone mass and formation of cyst-like brown tumors in and around the bone that fracture easily.
