Paget’s disease of the bone (early diagnosis): How far is far away?

Abstract

Introduction. Paget’s disease of the bone is a skeleton condition affecting bone remodelling of unknown cause. Bone formation and resorption, as parts of bone turnover which are normally coupled in healthy skeleton, in this condition are disconnected. We aim to introduce an adult male case with the condition which is also diagnosed with a multinodular goitre. This is a case report. This is a 60-year old male who is a former smoker and recently accused intermittent mild loss of hearing at left ear. Whole body bone scintigram (20mCi, Tc99m) showed increased uptake of the radiotracer with high bone affinity at parietal and occipital parts of the skull. Accidental multinodular goitre is diagnosed with a large cystic macronodule. Fine needle aspiration showed BETHESDA 2 with modest risk of haemorrhage and indication of surgery. 6 months after a dose of 5 mg zolendronic acid the bone markers were not increased and subsequent follow-up is necessary. Conclusion. Early diagnosis of Paget’s bone disease improves the potential risk of complications; however, distant potential complications need lifelong periodic check-up. The synchronous diagnosis of multinodular goitre with dominant cystic macronodule seems accidental in this male case.

Keywords

• paget's disease
• bone
• skull