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Parathyroid carcinoma (PCA), accounting for less than one per cent of all endocrine malignancies, is a rare cause of primary hyperparathyroidism. A diagnosis of parathyroid carcinoma may be challenging in the presence of localised disease and involves a histological diagnosis based on capsular, vascular, or perineural invasion or the presence of metastasis. Distant metastasis remains a rare presentation, with the lung being the most common site. Surgery remains the treatment of choice as radiotherapy and chemotherapy have proved to be of limited benefit in metastatic disease. This case reports suggests that radiofrequency ablation has the potential to be a novel and effective treatment option in these patients.

Slipped capital femoral epiphysis (SCFE) is characterized by displacement of the capital femoral epiphysis from the femoral neck. An 18-year-old male presented with left hip pain and a limping gait, following a trivial trauma. Radiological examination revealed bilateral SCFE. Clinically and biochemically, he had features of hypopituitarism. His prolactin levels were high and magnetic resonance imaging (MRI) scan showed a pituitary macroadenoma, suggesting a diagnosis of macroprolactinoma causing hypopituitarism and presenting as SCFE. He was started on dopamine agonist cabergoline as well as thyroxine and glucocorticoid replacement treatment. He was also scheduled for an orthopedic surgical procedure for his SCFE.

A 28-year-old woman presented with bone pains and progressive proximal muscle weakness of 2 years duration. Examination revealed significant bony tenderness over the spine and both hips and severe proximal muscle weakness in the lower limbs. The rest of the examination was normal. Biochemical evaluation showed parathyroid hormone (PTH)-dependent hypercalcaemia (serum calcium 12.4 mg/dL (normal 8.4–10.2); PTH >1900 pg/mL (normal 8–50)). Remaining blood bone biochemistry was as follows: phosphorus 2 mg/dL (normal 2.5–4.5), alkaline phosphatase 1112 U/L (normal 40–125), creatinine 0.9 mg/dL (normal 0.6–1.2) and 25 hydroxy vitamin D 12.5 ng/mL (normal 30–75). A skeletal survey performed was diagnostic of osteitis fibrosa cystica with multiple cystic lesions secondary to brown …

A 13-year-old girl presented with pain and progressive swelling over both hips of 2 years duration along with restriction of movements at the hips. There was no history of trauma, back ache, fever, renal calculi, polyuria, fractures and involvement of other joints. There was no similar illness in other family members. On examination, there were swellings of more than 20 cm over both hips with painful restriction of movements. The rest of the examination was unremarkable. The patient's blood biochemistry revealed a high-phosphorus level of 6 mg/dL (N: 2.5–5). The rest of the bone biochemistry was normal. The patient's …

Solid organ malignancies involving breast, prostate, and lung frequently metastasize to the skeleton. However, the occurrence of Paget's disease and metastatic bone disease in the same patient is uncommon. We report a case of a 63-year-old man who presented with back pain and a lump in the right breast. He was earlier diagnosed to have Paget's disease of bone based on characteristic skeletal radiological features, 99mTc methylene diphosphonate bone scan and elevated alkaline phosphatase, and treated with bisphosphonates, and his disease was in remission. Further evaluation revealed an underlying skeletal metastatic disease secondary to a breast malignancy. He underwent radical mastectomy with axillary node clearance, radiotherapy, and chemotherapy. In addition, he also received parenteral bisphosphonates for his skeletal metastatic bone disease.

Bisphosphonates are the first line therapy for treating post menopausal osteoporosis. Usually,they are well tolerated and have good efficacy in decreasing fracture risk with few adverse effects. The common side effect is upper gastrointestinal tract irritation like oesophagitis especially seen with oral bisphosphonates. One of the less commonly encountered adverse effect is atypical fracture of femoral shafts. Physicians who are prescribing bisphosphonates should be aware of this rare adverse effect. We report a case who presented to us with an atypical fracture.

A 19-year-old female patient presented with a history of primary amenorrhoea. Her developmental milestones were normal. There was no history of systemic illness or chronic medication use. She noticed thelarche at the age of 11 years and developed pubic hair at 13 years. She was born as the first child to second degree consanguinity and her younger sibling (sister) had attained menarche at 12 years of age. There was no growth stunting. On examination, she was 159 cm tall (with a mid-parental height of 162 cm) and had normal appearing female external genitalia and breasts (Tanner stage-5) and also had normal axillary and pubic hair development. There were no dysmorphic …

A 52-year-old man presented with upper abdominal pain and weight loss of 10 kg over 6 months. He had suffered from diabetes mellitus for the past 10 years and was on oral antidiabetic agents. He did not drink alcoholic. He had a history suggestive of steatorrhoea, which worsened following the intake of a fat-rich meal. On clinical examination, his body mass index was 20.5 kg/m2 and there was no evidence of nutritional deficiencies. Abdominal examination was unremarkable. His biochemical evaluation was as follows—haemoglobin 12.7 g/dL (normal range (N) 13–18), glycated haemoglobin 10.5% (N

A 19-year-old college girl presented with lack of linear growth since 11 years of age, primary amenorrhoea and failure of development of secondary sexual characters. There was no significant history prior to this. On examination, she was a cheerful girl, having a short stature. Her height was 135 cm (25th centile) and weight 36 kg. She had dry skin with a yellowish tinge. There was no goitre, dysmorphism or syndromic features. Her sexual maturity staging was prepubertal. …

A 19-year-old boy presented with history of progressive dysphagia and vomiting of 3 years duration. Dysphagia was more for liquids than solids. At the age of 8 he had vomiting and asthenia, and was noticed to have hyperpigmentation. At that time he was diagnosed with adrenal insufficiency and had been on glucocorticoid and mineralocorticoid replacement ever since. His mother had also noted that he had an absence of tears since early …

Bony manifestations of hyperparathyroidism are characterised by diffuse osteopenia, brown tumours, subperisoteal bone resorption, pathological fractures, terminal acrosteolysis and salt-and-pepper appearance of the skull, and are secondary to increased resorption. Osteosclerotic changes have been described more often with secondary hyperparathyroidism, especially with renal osteodystrophy, however association with primary hyperparathyroidism (PHPT) has been rarely reported.1 We report one such case of focal osteosclerosis with PHPT. A 23-year-old man presented with right lower limb swelling secondary to …