A case of paget's disease of the bone presented with hearing loss as the first symptom

A67-year-old woman presented to the audiology clinic with a complaint of bilateral hearing loss over the past two years. Routine biochemical screening showed an alkaline phosphatase level of 381 U/L, and she was referred to our endocrinology unit. Her vitamin D and parathyroid hormone levels, as well as thyroid, liver and kidney function test results, were within normal ranges. Cranial x-ray radiography showed an increase in the diploe distance and a sclerotic pattern in the calvarium; while whole body bone scintigraphy demonstrated a diffuse increase in radioactive substance involvement of the calvarium. Serum osteocalcin and spot urinary deoxypyridinoline levels were increased. The patient was diagnosed with Paget's disease with hearing loss as the first symptom, and she was started taking zoledronic acid treatment. Three months later, her alkaline phosphatase level had returned to the normal range, and audiologic examination showed a mild improvement in hearing.