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Journal of Case Reports
An Atypical Presentation of Secondary Hyperparathyroidism in the Emergency Department
Vivek Sharma, Ankur Verma, Wasil Rasool Sheikh, Meghna Haldar, Sanjay Jaiswal
Department of Emergency Medicine, Max Super Specialty Hospital, Patparganj, I.P. Extension, New Delhi, India.
Corresponding Author:
Dr. Vivek Sharma
Email: drviveksh91@gmail.com
Received: 25-OCT-2017 Accepted: 10-FEB-2018 Published Online: 20-FEB-2018
DOI: http://dx.doi.org/10.17659/01.2018.0014
Background: Secondary hyper-parathyroidism is over-production of parathyroid hormone secondary to a chronic abnormal stimulus for its production. Typically, this is due to chronic renal failure. Another common cause is vitamin D deficiency which is usually under diagnosed. Pathological fractures due to secondary hyper-parathyroidism are uncommon. Case Report: We present a case of a 27 year old male who presented to the Emergency Department (ED) in shock with complaints of uneasiness, breathing difficulty and generalized body-ache since six hours before arrival. Patient was investigated, resuscitated, provisionally diagnosed as septic shock and rhabdomyolysis and shifted to Intensive Care Unit for further management. Patient later complained of multiple joint pains and underwent X-ray imaging which revealed multiple pathological fractures. He underwent surgical fixation for the fractures and was finally diagnosed with hypo-vitaminosis D, secondary hyper-parathyroidism, hypocalcemia with bilateral pathological shoulder and femur fractures. He was later discharged in a stable condition after 14 days. Conclusion: Secondary hyper-parathyroidism can in rare circumstances present with severe manifestations like shock and multiple pathological bone fractures. Therefore secondary hyper-parathyroidism can be kept in the differential diagnosis while managing such patients.
Keywords : Fractures, Hypocalcemia, Kideny Failure, Parathyroid Hormone, Vitamin D Deficiency.
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