Primary Hyperparathyroidism Presenting as a Distal Femur Pathologic Fracture in an Adolescent
Taylor Anthony, Alexander J. Baur, Ashwin Suresh, Jasmine Lopez, Kevin Mo, Mohan V. BelthurCase:
A 17-year-old adolescent boy presented with a pathologic distal femur fracture and bilateral distal femoral metadiaphyseal lytic lesions. Multidisciplinary evaluation confirmed bilateral distal femoral brown tumors associated with primary hyperparathyroidism secondary to a parathyroid adenoma. Treatment included bone biopsy, curettage, grafting, and retrograde locked intramedullary nail, followed by definitive partial parathyroidectomy. The contralateral metadiaphyseal lesion was treated with corrective osteotomy and prophylactic intramedullary stabilization.
Conclusion:
Primary hyperparathyroidism may initially present with symptomatic skeletal manifestations and, rarely, pathologic fracture. Multifocal lytic lesions are a diagnostic red flag which should prompt early biochemical evaluation. In advanced skeletal involvement, prophylactic stabilization can reduce risk of subsequent fracture.