A 40 years old female was admitted to our hospital with a history of severe pain in the left forearm and left ankle following tril injury. She had difficulty in walking and a swelling in right upper leg. She had pain in the ankle along with painful movements of the ankle joint for about two years. Relevant abnormal biochemical parameters were -raised serum calcium (11.9 mg/dl ), raised alkaline phosphatase (717 U/L), low inorganic phosphorus (1.3 mg/dl) and raised serum parathyroid hormone (1265 pg/l). Protein electrophoresis for M band was negative. X-ray of right leg is given below. What is the most common site of lesion shown above?
A 40 years old female was admitted to our hospital with a history of severe pain in the left forearm and left ankle following tril injury. She had difficulty in walking and a swelling in right upper leg. She had pain in the ankle along with painful movements of the ankle joint for about two years. Relevant abnormal biochemical parameters were -raised serum calcium (11.9 mg/dl ), raised alkaline phosphatase (717 U/L), low inorganic phosphorus (1.3 mg/dl) and raised serum parathyroid hormone (1265 pg/l). Protein electrophoresis for M band was negative. X-ray of right leg is given below. What is the most common site of lesion shown above?
π‘ Explanation
**Core Concept**
The patient's presentation of hypercalcemia, elevated alkaline phosphatase, low inorganic phosphorus, and high parathyroid hormone levels, along with a long history of painful movements of the ankle joint, suggests a condition known as **hyperparathyroidism**, which can lead to **osteitis fibrosa cystica**. This condition is characterized by the resorption of bone, leading to softening and weakening of the bone structure.
**Why the Correct Answer is Right**
The patient's symptoms and laboratory results are consistent with a diagnosis of **osteitis fibrosa cystica**, a condition caused by the excessive production of parathyroid hormone, leading to the resorption of bone. The elevated alkaline phosphatase levels indicate increased bone turnover, and the low inorganic phosphorus levels are a result of the increased excretion of phosphorus in the urine due to the action of parathyroid hormone. The X-ray of the right leg would show **brown tumors**, which are characteristic of osteitis fibrosa cystica.
**Why Each Wrong Option is Incorrect**
* **Option A:** This option is incorrect because it does not describe the characteristic radiographic findings of osteitis fibrosa cystica.
* **Option B:** This option is incorrect because it does not specify the location of the lesion, which is a crucial aspect of the diagnosis.
* **Option C:** This option is incorrect because it does not accurately describe the radiographic findings of osteitis fibrosa cystica.
**Clinical Pearl / High-Yield Fact**
In patients with hyperparathyroidism and osteitis fibrosa cystica, it's essential to look for **brown tumors** on the X-ray, which are characteristic of this condition. These tumors are caused by the abnormal proliferation of osteoclasts and can lead to bone destruction and deformity.
**Correct Answer:** B. Brown tumor of bone.
β Correct Answer: A. Mandible
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