The images shown here are from a 75 years old man who was incidentally noted to have asymptomatic hypercalcemia (adjusted calcium level of 2.66 mmol/L and alkaline phosphatase (ALP) of 245 U/L). Heat stable ALP fraction was 0.15 (< 0.2 suggestive of bone origin). Parathyroid hormone was suppressed. Skeletal survey showed the following findings: cotton wool appearances of the skull; typical radiological features of osteosclerosis alternating with areas of osteolysis and bone expansion at the right hemi-pelvis. X-ray features were suggestive of Paget’s disease. Bone scan was performed and showed disease activity of the skull, right hemi-pelvis and left distal part of the femur. Whole body 18-flurodeoxyglucose body positron emission tomography (PET) did not show any evidence of an underlying malignancy. Because of the involvement of weight bearing bone, the patient was prescribed with intravenous palmidronate, after which the serum calcium and ALP subsequently normalized. The patient is currently being regularly followed-up at the Geriatrics clinic with regular monitoring of the serum calcium and ALP levels.
Paget’s Disease
