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Pediatr Emerg Care ; 37(6): e339-e341, 2021 Jun 01.
Article in English | MEDLINE | ID: mdl-30973495

ABSTRACT

BACKGROUND: When evaluating an infant with unexplained fractures for child abuse, it is important to evaluate for possible causes of underlying bone fragility. CASE: A 7-month-old infant was found to have a parathyroid hormone (PTH)-related peptide-secreting mesoblastic nephroma. In spite of having an elevated serum calcium, depressed serum phosphate, and high levels of PTH-related peptide, he had no demineralization or other hyper parathyroid-related bone changes. Instead, he had multiple classic metaphyseal lesions, fractures of differing ages including a proximal clavicle fracture, and current and past bruising. No fractures typical of bone insufficiency were present. These findings are highly indicative of abuse in addition to his hormone-secreting tumor. CONCLUSIONS: In spite of this child's abuse findings, endogenous or tumor-related hyper PTH should be in the differential of underlying bone fragility. Children with disorders that could cause injury susceptibility can also be abused.


Subject(s)
Fractures, Bone , Hypercalcemia , Kidney Neoplasms , Bone and Bones , Child , Fractures, Bone/diagnosis , Fractures, Bone/etiology , Humans , Infant , Male , Parathyroid Hormone , Parathyroid Hormone-Related Protein
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