Description
A 72-year-old man presented for general health check. He was asymptomatic except for hard of hearing and uses hearing aid for the last 4 years. Clinical examination revealed very prominent tortuous superficial temporal veins bilaterally, more on the left side (figure 1) with no bruit and a warm non-tender skull on palpation. Serum chemistries showed significantly elevated alkaline phosphatase 1520 U/L (normal, 45–140 U/L) with normal liver, kidney and haematological parameters. Serum calcium, phosphorus, 25-hydroxy vitamin D and parathyroid hormone levels were normal. Skull radiograph showed moth-eaten appearance suggestive of Pagetoid bone (figure 2). With this clinico-biochemical picture in an otherwise asymptomatic individual, Paget's disease of bone was strongly considered. It was confirmed by significant uptake of technetium-methylene diphosphonate (MDP) in skull and right hemipelvis. He was managed with intravenous zoledronic acid, calcium and vitamin D supplementation. Serum alkaline phosphatase normalised at 6 months follow-up, though hearing and scalp vein...
http://ift.tt/2qhXPKB
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου