25-Year-Old Man Recovers from Hyperparathyroidism through Medication and Successful Surgery

Hyperparathyroidism is often overlooked, especially in young adults, and can manifest in unexpected ways—such as fractures following minor injuries. This case highlights the journey of a 25-year-old male patient who initially presented with a seemingly ordinary arm fracture but was later diagnosed with primary hyperparathyroidism caused by a parathyroid adenoma. After comprehensive medical management and surgical intervention at the First Affiliated Hospital of Anhui Medical University in June 2020, his condition significantly improved. His calcium levels normalized, symptoms resolved, and he made a full recovery within weeks.

Understanding the Initial Presentation

The patient, Mr. Xu, experienced a minor fall one week prior to seeking medical attention. Although the impact appeared minimal, he developed severe pain, swelling, and limited mobility in his left upper arm. He visited the orthopedic department, where an X-ray revealed not only a fracture but also the presence of a brown tumor—a rare bone lesion associated with prolonged high calcium levels. Recognizing this as a potential sign of underlying endocrine dysfunction, the orthopedic team referred him to the endocrinology department for further evaluation.

Upon examination, clinical suspicion for hyperparathyroidism was raised due to the unusual nature of the fracture and radiological findings. Brown tumors are not cancerous but represent areas of bone resorption caused by excessive parathyroid hormone (PTH) activity. Given that such lesions typically occur in younger patients with long-standing undiagnosed parathyroid disorders, immediate admission was recommended for detailed diagnostic workup.

Diagnostic Process and Confirmation

A series of laboratory tests were conducted upon hospitalization. Blood analysis showed markedly elevated serum calcium at 2.89 mmol/L (normal range: 2.1–2.6 mmol/L), while phosphate levels were low at 0.58 mmol/L—both classic indicators of hyperparathyroidism. More strikingly, the patient's PTH level was found to be ten times higher than normal, reaching 1800 pg/mL.

Imaging Studies Confirm Parathyroid Adenoma

To locate the source of hormone overproduction, advanced imaging techniques were employed:

• Parathyroid ECT scan: Revealed abnormal tracer uptake in the right lobe and inferior region of the thyroid, suggesting a hyperfunctioning nodule.
• Ultrasound and contrast-enhanced CT: Both confirmed a solid mass consistent with a parathyroid adenoma located posterior to the right thyroid lobe.

These results collectively supported the diagnosis of primary hyperparathyroidism due to a benign parathyroid tumor. With the cause identified, a multidisciplinary approach involving endocrinologists and surgeons was initiated to plan definitive treatment.

Treatment Strategy: From Medical Stabilization to Surgery

Prior to surgery, it was crucial to stabilize the patient's calcium levels to reduce surgical risks and prevent complications such as cardiac arrhythmias. The treatment protocol included:

• Intravenous saline infusion: To enhance renal excretion of excess calcium.
• Synthetic calcitonin (salmon calcitonin injection): Administered to rapidly lower serum calcium by inhibiting bone resorption.

While these measures helped bring calcium under control, the definitive cure required surgical removal of the adenoma. A collaborative decision was made with the surgical team, and a minimally invasive parathyroidectomy was successfully performed. The excised tissue was sent for pathological analysis, which confirmed the diagnosis of a benign parathyroid adenoma—no signs of malignancy were detected.

Postoperative Recovery and Clinical Outcomes

Immediately after surgery, a dramatic improvement was observed. Serum calcium dropped to 1.52 mmol/L on post-op day one, and PTH levels decreased from 1800 pg/mL to 250 pg/mL—indicating effective removal of the hyperactive gland.

However, the sharp decline in calcium triggered transient hypocalcemia, leading to new symptoms including perioral numbness and tingling in the fingertips—classic signs of low calcium. These were promptly managed with oral supplementation:

• Calcium carbonate D3 chewable tablets (II)
• Calcitriol soft capsules (active form of vitamin D)

Within days, neuromuscular symptoms subsided. Over the next three weeks, the patient regained strength and mobility. After 20 days of inpatient care, he was discharged with clear instructions for follow-up and long-term monitoring.

Key Recommendations for Long-Term Management

Although the patient responded well to treatment, ongoing vigilance remains essential. Fracture healing may take several months, and psychological stress related to physical limitations should not be underestimated. Key post-discharge advice includes:

Nutrition and Lifestyle Adjustments

Maintaining adequate calcium and vitamin D intake supports bone regeneration. Patients are encouraged to consume calcium-rich foods such as dairy products, eggs, lean meats, fish, and shellfish. Additionally, spending 30 minutes outdoors daily promotes natural vitamin D synthesis through sunlight exposure.

Regular Monitoring and Early Warning Signs

Because recurrence or residual disease is possible, routine blood tests are critical. Patients should have periodic assessments of:

• Serum calcium
• Phosphorus
• Parathyroid hormone levels

If symptoms like muscle cramps, twitching, or numbness return, they should consider hypocalcemia and adhere to prescribed supplements. In some cases, lifelong calcium or active vitamin D therapy may be necessary.

Clinical Insights and Broader Implications

This case underscores an important lesson: not all fractures result from trauma. In younger individuals, a fracture following a minor incident should prompt clinicians to investigate metabolic bone diseases, particularly those linked to endocrine imbalances.

In this instance, timely referral, accurate diagnostics, and coordinated care between specialties led to a successful outcome. The patient avoided further skeletal damage and regained normal function. It also highlights the importance of interdisciplinary collaboration—orthopedic red flags triggering endocrine investigation can make all the difference.

Ultimately, this story serves as a reminder that behind every atypical injury lies the possibility of an underlying systemic condition. For healthcare providers, maintaining a broad differential diagnosis—especially in young patients with unexplained fractures—is vital for delivering precise, life-changing care.