An elderly woman presented with isolated raised serum alkaline phosphotase level. On examination, she was noted to have the following features:
- Enlarged skull with frontal bossing
- Anterior bowing of legs
Other significant findings
- Hearing aid
- Kyphosis secondary to osteoporotic vertebral collapse
Workup
- Skeletal survey
- Skull X-Ray showing thickening of skull vault and cotton wool areas of sclerotic bone in keeping with Paget’s disease
- Pure tone audiometry
- Echocardiogram
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- Pagets’ Spine
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- Paget’s Femur
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- Pagets’ Skull
Diagnosis
- Bone scan
Management
- Monitoring of symptoms of complications of Paget’s disease, including bone pain, heart failure and hearing impairment
- Monitoring of serum ALP level
- Bisphosphonates if necessary