Pune woman breaks femur while getting out of bed, doctors detect metabolic disorder
Pune: It was indeed a mystery for the doctors at a private hospital in the city. A 23-year-old woman had come in with a broken femur, the longest and strongest bone in the human body. The doctors first assumed it was a fall injury, but were taken aback when the woman said she had suffered the fracture while simply getting out of bed in the morning.
The doctors called for a battery of tests and that's when they discovered that a rare metabolic disorder in her had caused calcium levels to drop, leaving the woman with brittle bones.
The problem was in the neck, where the parathyroid gland regulates calcium metabolism and bone strength by secreting parathormone. In the woman's case, excessively high parathormone levels had depleted calcium from her bones. "Tests showing elevated blood calcium and parathormone levels pointed to an underlying metabolic disorder.
As for her fracture, we performed an open reduction and stabilised the femur with screws," said Dr Rahul Salunkhe, the woman's treating doctor and head of orthopaedics at DPU Super Speciality Hospital in Pimpri.
But doctors still suspected something deeper. The femur - because of its load-bearing nature - does not break so easily. The woman underwent a sonography of the neck and a CT scan, but the tests did not detect any enlargement of the parathyroid gland.
"But further investigations with a parathyroid nuclear scan revealed an ectopic parathyroid adenoma, an extremely rare tumour located in the chest cavity. Such tumors account for just 1–2% of all parathyroid adenomas, which made this woman's case very rare," said Dr Anil Menon, head of the hospital's endocrinology department.
The tumour had triggered the excess production of parathormone, which led to calcium depletion.
The woman was referred to the oncology department where Dr Samir Gupta, head of surgical oncology, and team performed a video-assisted thoracoscopic (keyhole) surgery to remove the tumour. "The procedure uncovered the lesion embedded within the thymus gland, resting over the heart. The surgery was complex, but use of keyhole techniques ensured a quick recovery with minimal scarring," said Dr Gupta. The surgery, performed in Jan this year was a success, doctors said, and after a period of follow-ups, the patient was declared recovered.
She was also put on supplemental calcium and Vitamin D therapy while doctors closely monitored her calcium levels.
Dr Salunkhe from the orthopaedics department said such serious fractures, especially in young people, needed thorough investigations. He said: "These fractures may not only be indicative of underlying systemic diseases or bone pathology, but also demand timely intervention to restore function and prevent complications."
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