ENDOCRINE DISORDERS
A 58 year-old male received a referral to his physician from his dentist. This patient exhibited progressive swelling (over the period of the last 4 years) in the right and left maxilla which was causing difficulty with chewing during eating. Upon examination, the physician found swelling in the frontal, malar, and maxillary regions of the skull.
1. What is your initial presumptive diagnosis?
2. Describe the disease process, any additional associated symptoms, and expected prognosis?
3. What labs should be ordered to determine the cause of the bony growths and what labs values would you expect to see if your initial diagnosis is correct?
1. The presumptive diagnosis in the above case is Pagets disease. It is the disease involving bones of the body. It is characterised by impaired bone resorption and remodelling resulting in bony deformities.
Pagets disease may also affect the facial bones and teeth leading to difficulty in chewing. The swelling in maxillary, malar and frontal region of skull is indicative of pagets disease.
2. Pagets disease is characterised by dysregulated osteoclastic activity. This results in increased bone resorption and osteolysis. Osteolysis in turn activates osteoblasts causing bone remodelling in disorganized fashion (mosaic pattern). This cause bone deformity.
The symptoms of pagets disease include bone pain, swelling, deformity, arthritis, associated fractures.
Prognosis : the disease is usually progessive and worsens with time. The treatment is symptomstic and there is no cure.
Sometimes pagets disease leads to bone cancer.
3. Lab tests :
- blood test show elevated alkaline phosphatase and serum hydroxyproline
- bone xrays
- urinalysis show markers of bone turnover
ENDOCRINE DISORDERS A 58 year-old male received a referral to his physician from his dentist. This...
A 58 year-old male received a referral to his physician from his dentist. This patient exhibited progressive swelling (over the period of the last 4 years) in the right and left maxilla which was causing difficulty with chewing during eating. Upon examination, the physician found swelling in the frontal, malar, and maxillary regions of the skull. What is your initial presumptive diagnosis? What is your alternative diagnosis? Describe the disease process, any additional associated symptoms, and expected prognosis? What labs...