Radiographical appearance of osteitis fibrosa cystica in primary hyperparathyroidism before and after parathyroidectomy.

To cite: Sandoval MAS. BMJ Case Reports Published online: [please include Day Month Year] doi:10.1136/ bcr-2012-008086 DESCRIPTION The case of a patient with primary hyperparathyroidism with classic and severe skeletal involvement has been previously reported. Briefly, it was the case of a 63-year-old woman who presented with multiple repeated fractures, the latest of which were of both femoral shafts. Primary hyperparathyroidism was diagnosed based on elevated calcium with unsuppressed parathyroid hormone (PTH) levels. The excess PTH secretion was localised to a right inferior parathyroid adenoma. She eventually underwent parathyroidectomy with documented decline in calcium and PTH levels. A preoperative skeletal survey radiograph was performed on November 2008, 3 months before parathyroidectomy. Among the findings was a lytic lesion of the fourth metacarpal of the right hand, compatible with osteitis fibrosa cystica. Repeat x-ray performed on April 2012 or 38 months after parathyroidectomy showed complete remineralisation of the previously noted lytic lesion. The area previously occupied by the osteitis fibrosa cystica now appears hyperdense indicative of bone formation (figure 1). Her fractures have also healed and there has been no recurrence of any fracture since the surgery. She has also been ambulatory since then. Areas of the bone affected by osteitis fibrosa cystica are known to resolve, with radiographs showing hyperdensities within 3 months of successful parathyroidectomy. These radiographical changes are also accompanied by histological changes in bone, showing an osteoblastic or healing response.