25-Year-Old Man Recovers from Hyperparathyroidism After Combined Medical and Surgical Treatment
Fractures following minor trauma are often dismissed as simple injuries, but they can sometimes signal an underlying systemic condition. In this case, a seemingly routine arm fracture led to the discovery of primary hyperparathyroidism caused by a parathyroid adenoma in a 25-year-old man. Initially visiting orthopedics after a fall, the patient was found to have a brown tumor—a rare bone lesion linked to metabolic bone disease—prompting referral to endocrinology. Comprehensive evaluation revealed significantly elevated calcium and parathyroid hormone levels, confirming the diagnosis. With timely medical management and surgical intervention, the patient achieved full recovery, highlighting the importance of interdisciplinary care in diagnosing atypical fractures.
Understanding the Case: A Young Patient with Atypical Fracture
This clinical case involves a 25-year-old male who presented with severe pain, swelling, and limited mobility in his left upper arm after a minor fall. While such symptoms might typically suggest a traumatic injury, further investigation uncovered a more complex origin. Imaging revealed not only a fracture but also the presence of a brown tumor—an erosive bone lesion associated with long-standing hyperparathyroidism. This finding raised suspicion for an endocrine disorder rather than isolated trauma.
Patient Profile & Clinical Timeline
Age/Gender: 25-year-old maleDiagnosis: Primary hyperparathyroidism due to parathyroid adenomaHospital: The First Affiliated Hospital of Anhui Medical UniversityDate of Admission: June 2020Treatment Approach: Initial medical stabilization with intravenous saline, calcitonin, oral calcium, and active vitamin D, followed by surgical removal of the adenomaTreatment Duration: 20-day hospitalization with outpatient follow-up scheduled at one monthOutcome: Normalization of serum calcium and PTH levels; resolution of symptoms; successful discharge
Initial Evaluation: From Orthopedics to Endocrinology
The patient first sought care in the orthopedic department after sustaining a low-impact fall. X-rays confirmed a fracture in the left humerus, but radiologists also noted signs of cortical thinning and a lytic lesion consistent with a brown tumor. Recognizing that such findings are uncommon in young adults without significant trauma or malignancy, the orthopedic team referred the patient to endocrinology for metabolic workup.
Upon consultation, detailed imaging—including ECT (Sestamibi scan), high-resolution ultrasound, and contrast-enhanced CT—revealed abnormal tracer uptake in the right inferior parathyroid gland, strongly suggesting a functioning parathyroid adenoma. These advanced diagnostics play a crucial role in preoperative localization, improving surgical success rates and minimizing complications.
Medical and Surgical Management Strategy
Given the patient's markedly elevated serum calcium level of 2.89 mmol/L (normal range: 2.1–2.6 mmol/L) and phosphorus deficiency (0.58 mmol/L), immediate medical intervention was initiated to reduce the risk of cardiac arrhythmias and acute kidney injury. The treatment protocol included:
- Intravenous isotonic saline infusion to promote calciuresis
- Subcutaneous salmon calcitonin to rapidly lower serum calcium
- Close monitoring of ECG and electrolyte balance
Once stabilized, the patient underwent minimally invasive parathyroidectomy. Intraoperative PTH monitoring showed a >50% drop within 10 minutes post-excision, confirming successful removal of the hyperfunctioning tissue. Histopathological analysis confirmed benign parathyroid adenoma, ruling out carcinoma or hyperplasia.
Postoperative Recovery and Outcomes
Immediately after surgery, the patient's parathyroid hormone (PTH) dropped from 1800 pg/mL to 250 pg/mL, and serum calcium fell to 1.52 mmol/L—indicating "hungry bone syndrome," a known complication following resection of long-standing hyperparathyroidism. This transient hypocalcemia required prompt supplementation with oral calcium carbonate D3 chewable tablets and calcitriol (active vitamin D) to prevent neuromuscular irritability.
Symptoms such as perioral numbness and tingling in the extremities gradually resolved over two weeks. The patient regained normal limb function and was discharged on day 20 with clear instructions for ongoing care and surveillance.
Key Considerations for Long-Term Health
While the surgical outcome was excellent, long-term vigilance remains essential. Patients recovering from primary hyperparathyroidism must adopt lifestyle and dietary habits that support skeletal healing and mineral homeostasis. Key recommendations include:
Nutrition and Lifestyle Adjustments
Maintain adequate intake of calcium-rich foods such as dairy products, eggs, lean meats, fatty fish (like salmon and sardines), and shellfish. Daily outdoor activity for at least 30 minutes helps boost natural vitamin D synthesis, which enhances calcium absorption and supports bone remodeling.
Ongoing Monitoring and Symptom Awareness
Regular follow-up appointments should assess serum calcium, phosphate, and PTH levels every 3–6 months during the first year. Any recurrence of symptoms like muscle cramps, twitching, or numbness may indicate persistent or recurrent disease and warrants immediate evaluation. Lifelong adherence to prescribed supplements—especially calcium and active vitamin D—is often necessary during the bone re-mineralization phase.
Clinical Insights: Why Early Diagnosis Matters
This case underscores a critical point in modern medicine: not all fractures are created equal. In younger individuals, fractures resulting from minimal trauma should trigger suspicion for metabolic bone disorders, particularly hyperparathyroidism. Brown tumors, though rare, are pathognomonic for prolonged excess PTH secretion leading to osteoclast overactivity and focal bone resorption.
Early detection saves bone mass and prevents irreversible damage. Without identifying the root cause, orthopedic interventions alone—such as plating or pinning—would fail to stop progressive skeletal deterioration. Fortunately, this patient benefited from early multidisciplinary collaboration between orthopedics, endocrinology, radiology, and surgery, enabling curative treatment before widespread bone loss occurred.
Parathyroid adenomas are generally benign, yet their impact on calcium metabolism can be profound. When diagnosed promptly and managed appropriately, outcomes are highly favorable. This case serves as a reminder that behind every unusual fracture, there may be a hidden endocrine story waiting to be uncovered—with potentially life-changing implications.