Serial pathologic fractures of five long bones on four separate occasions in a patient with primary hyperparathyroidism, challenges of management in a developing country: a case report

Olatoke, Samuel; Agodirin, Olayide; Rahman, Ganiyu A.; Habeeb, Olufemi; Jimoh, Rabiu O.; Ahmed, BA; Biliaminu, Sikiru Abayomi; Oyedepo, Olanrewaju Olubukola

doi:10.11604/pamj.2013.15.45.2501

Cited by 6 publications

(5 citation statements)

References 11 publications

(18 reference statements)

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“…This might be particularly useful especially in laboratory/medical settings relying on limited resources, in which PTH determination is difficult or not possible. In this regard the use of the Ca/P ratio for the diagnosis of PHPT can be extended to every clinical and laboratory setting worldwide, including developing countries, reducing health inequalities due to limited access to diagnostic facilities, such as hormone measurements . Thanks to its simplicity, the Ca/P ratio could be useful in clinical settings characterized by large inflow of patients (eg, general practitioner, emergency room, PHPT screening of osteoporotic patients).…”

Section: Discussionmentioning

confidence: 99%

“…In this regard the use of the Ca/P ratio for the diagnosis of PHPT can be extended to every clinical and laboratory setting worldwide, including developing countries, reducing health inequalities (40) due to limited access to diagnostic facilities, such as hormone measurements. (41,42) Thanks to its simplicity, the Ca/P ratio could be useful in clinical settings characterized by large inflow of patients (eg, general practitioner, emergency room, PHPT screening of osteoporotic patients). In all these conditions Ca/P may perform very well, allowing cost savings and selecting patients as candidates for second-line diagnostic procedures such as PTH assay and imaging.…”

Section: Discussionmentioning

confidence: 99%

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Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

et al. 2017

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Primary hyperparathyroidism (PHPT) diagnosis is challenging and is based on serum calcium (Ca) and parathyroid hormone (PTH). Because serum Ca and phosphorous (P) are inversely related in PHPT, we investigated the diagnostic value of the serum Ca/P ratio in the diagnosis of PHPT. We report a single‐center, case‐controlled, retrospective study including 97 patients with documented PHPT and compared them with those of 96 controls (C). The main outcome measures were: serum PTH, 25‐OH vitamin D, Ca, P, albumin, and creatinine. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the serum Ca/P ratio were calculated. The results were verified using an independent, anonymous set of data extracted from a laboratory database containing over 900 million entries. A total of 35 (36.1%) PHPT patients had normocalcemic PHPT (NCHPT). Ca and PTH were significantly higher in PHPT than in C (p < 0.0001). P was significantly lower in PHPT than in C (p < 0.0001). The Ca/P ratio was significantly higher in PHPT than in C (p < 0.0001). Receiver‐operating characteristic (ROC) curves analyses identified a cutoff of 2.71 (3.5 if Ca and P are expressed in mg/dL) for Ca/P ratio with a sensitivity and specificity of 86% and 87%, respectively (p < 0.0001), confirmed by the independent, big data approach. In conclusion, Ca/P is a valuable tool for the diagnosis of PHPT and is of superior value compared to serum Ca alone, especially in NCPHT. Because Ca/P is simple, inexpensive, and easily accessible worldwide, this ratio is useful for PHPT diagnosis, especially in laboratory/medical settings relying on limited resources, such as low‐income countries. © 2017 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

et al. 2017

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“…The quality of evidence of studies included in this review mostly (17/18) comprise of case series and cohort studies, however one study, number 11 by Olatoke et al , is a single case report, thus representing low quality evidence. Additionally, this study offered no statistical benefit, however this report of only a single case is due to and demonstrates the challenges of FP in this country, which speaks to the aim of this review ( 45 , 61 ).…”

Section: Discussionmentioning

confidence: 75%

“…Combined 99m Tc sestamibi/US use for preoperative localisation has been reported to have a sensitivity of 96%, in keeping with the sensitivity of preoperative localisation from the developing countries in this study ( 58 ). In a single lower middle-income country, Nigeria, Olatoke et al [2013] demonstrated preoperative localisation to be possible, but not feasible, as each 99m Tc sestamibi test required a 250 km journey to access a facility with the necessary equipment ( 45 ).…”

Section: Discussionmentioning

confidence: 99%

Feasibility of focused parathyroidectomy in developing countries—a scoping review

Rugnath,

Kinoo

2024

Gland Surg

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Background The mainstay of treatment of primary hyperparathyroidism involves a parathyroidectomy, which depending on the number of affected parathyroid glands and the availability of resources, may involve a bilateral neck exploration with four gland assessment or a minimally invasive, focused parathyroidectomy (FP) necessitating pre-operative localisation. The feasibility of the latter is yet to be demonstrated in developing countries. Methods A scoping review was performed with published literature evaluated from the past 15 years (2007 & onwards). Articles were screened and only included if they discussed FP, preoperative localisation, economic impact and they originated from a developing country (upper middle or lower middle-income). Results A total of 18 articles met the inclusion criteria, comprising seven developing countries (two upper middle-income and five lower middle-income countries). Preoperative localisation was performed in all studies, with overall accuracy rates of 75.5% for ultrasound and 85.7% for 99m Tc sestamibi. A total 1,202 patients (70%) had FP. Five hundred and fifty-five patients underwent FP without intraoperative adjuncts and 647 underwent FP with intraoperative adjuncts, with adjusted cure rates of 95.3% and 99.2% respectively. Overall cure rate for FP was 96.4%. Conclusions With access to accurate preoperative localisation and excellent cure rates with and without intraoperative adjuncts, we conclude that FP is feasible in developing countries.

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“…Occasionally, patients can present with a mandibular fracture, as reported in a patient with primary hyperparathyroidism. 12 Giant cell epulis and Sagliker syndrome are also possible manifestations. The mandible is more often affected than the maxilla, but bimaxillary manifestation is common as well.…”

Section: Discussionmentioning

confidence: 99%

Secondary hyperparathyroidism causing increased jaw bone density and mandibular pain: a case report

Aerden

Grisar

Nys

et al. 2018

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

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We present the case of a 32-year-old male patient complaining of recurrent mandibular pain for 3.5 years. Panoramic radiography indicated increased cortical density of the mandibular lower border. Scintigraphy and single-photon emission computed tomography revealed metabolic hyperactivity in that region without pathologic lymph nodes. A bone biopsy specimen of the mandibular lower border did not have inflammation or cytologic atypia. Endocrinologic investigation confirmed secondary hyperparathyroidism as a result of hypovitaminosis D. Several weeks after starting therapy with oral vitamin D supplements, the symptoms completely disappeared. Increased cortical density is a rare manifestation of secondary hyperparathyroidism, which normally causes the lamina dura to vanish and produces a ground-glass appearance as a result of blurring of the trabecular bone pattern. Because focal hyperostosis can have multiple benign or malignant causes, radiologic examination of the jaw bones is indispensable for evaluating orofacial pain. Increased cortical density may be caused by metabolic diseases, requiring further investigations, including biopsy and blood analysis.

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Serial pathologic fractures of five long bones on four separate occasions in a patient with primary hyperparathyroidism, challenges of management in a developing country: a case report

Cited by 6 publications

References 11 publications

Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

Feasibility of focused parathyroidectomy in developing countries—a scoping review

Secondary hyperparathyroidism causing increased jaw bone density and mandibular pain: a case report

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