Paget's disease
Incidental findings
+ve signs Sabre tibia, increased head size, hearing aids, kyphosis
Differential diagnosis Paget’s
Function Mobility, hearing
Tests Urine analysis: renal stones
Plain X rays
Bone scan
Calcium – normal; ↑ALP
Old photos
Extensions

  • Feel tibia for warmth
  • Test hearing
  • Fundoscopy: optic atrophy / angioid streaks
  • Cardiovascular: High output cardiac failure
Questions

  • Hat size increased
  • Bone pain
  • Hearing loss
  • Fractures
Notes

  • Complications: Fractures, Cord compression / root lesions / cranial nerve signs, hypercalcaemia, high output cardiac failure, sarcomatous change
  • Hearing loss can be either involvement of ossicles or compression of VIII by skull foramina
  • Rx: bisphosphonaes, calcitonin