P-14 A case of Paget's disease of bone presenting at early stages of life

Abstract

Abstract Paget's disease of bone is the metabolic bone disease that affects 2-4% of individuals over age 55 in European nations. The disease may be asymptomatic and can be detected incidentally through x-rays or biochemical tests conducted for another condition. It can also manifest as bone pain, deformity, fracture, Here, we present a case of Paget's bone disease that manifested at a young age. A 47-year-old female was referred to an endocrinology outpatient clinic due to a nonfunctional pituitary gland microadenoma. She has had constant pain in the right thigh region for the past two years, and no fractures have ever been reported. During the physical examination, the patient's right femur was sensitive to palpation. The results of the standard laboratory test were as follows: Creatinine: 0.61 mg/dl (0-1.2 mg/dl), Albumin: 50 g/L (35-52 g/L), Calcium: 9.8 mg/dl (8.8-10.6 mg/dl), Phosphorus: 4.2 mg/dl (2.6-4.5 mg/dl), PTH (Parathyroid Hormone): 33 ng/L (15-65 ng/L), Alkaline Phosphatase: 524 U/L (33-98 U/L) and 25-OH vitamin D is 43.7 mcg/L. A bone scintigraphy was performed due to the patient's elevated alkaline phosphatase levels and bone pain. The scintigraphy revealed elevated osteoblastic activity in a sclerotic lesion expanding the right femoral cortex, and the results were reported in accordance with Paget's disease. A biopsy of the right femur lesion was performed due to the patient's young age and to rule out other diagnosis such as osteosarcoma or bone metastases. The pathology results revealed thickened and distinct cement lines along with calcified bone fragments, consistent with Paget's disease. The patient was administered 5 mg of IV zoledronic acid, and the alkaline phosphatase level was determined to be 123 U/L (Reference Range: 33-98) at the one-month control following treatment. Paget's disease can be diagnosed in young people. Therefore, it is important to take into account even a slight increase in ALP levels that is linked to early radiological abnormalities.