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Uysal C, Yilmaz T, Ozkan H, Canoz O, Tokgoz B. The refractory secondary hyperparathyroidism presenting with retro-orbital brown tumor: a case report. BMC Nephrol 2024; 25:15. [PMID: 38182973 PMCID: PMC10770921 DOI: 10.1186/s12882-024-03455-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/01/2024] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Tertiary hyperparathyroidism describes the autonomous and excessive secretion of parathyroid hormone (PTH) by the parathyroid glands after longstanding secondary hyperparathyroidism in chronic kidney disease. Brown tumors are a sign of uncontrolled hyperparathyroidism. In this case, we have reported a refractory and destructive hyperparathyroidism storm. Also, it presented with atypical onset and unexpected adenoma location. CASE PRESENTATION A 37-year-old man was diagnosed with end-stage kidney disease 22 years ago. He has been undergoing dialysis treatment since that time. Recently, he was admitted to the ophthalmology department due to the unilateral anterior bulging of the right eye and drooping of the eyelid. Magnetic resonance imaging exhibited an extraconal mass lesion located in the right orbital posterior superolateral position. Computerized tomography scans considered expansile bone lesion with peripheral calcification and originating from the sphenoid wing. The bone mass lesion was resected via craniotomy due to the compressive effect. The pathological findings were consistent with brown tumors. Plasma intact PTH level was 4557 pg/mL. The patient informed that he underwent parathyroidectomy and two leg fractures operation in a medical query. Parathyroid scintigraphy determined three distinct foci consistent with adenomas and one of them was in mediastenum. Second parathyroidectomy was recommended to the patient but the patient refused surgery. Despite his medication and dialysis regimen being revised, PTH levels were maintained at higher levels in follow-up. CONCLUSIONS We presented a hyperparathyroidism case that was resistant to all treatments and exhibited all the severe complications in a long-term dialysis patient. Furthermore, this case has revealed the importance and difficulty of secondary hyperparathyroidism management.
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Affiliation(s)
- Cihan Uysal
- Department of Nephrology, Erciyes University School of Medicine, Dede Efendi Street, Köşk District, Kayseri, Melikgazi, 38030, Turkey.
| | - Tugba Yilmaz
- Department of Nephrology, Erciyes University School of Medicine, Dede Efendi Street, Köşk District, Kayseri, Melikgazi, 38030, Turkey
| | - Hamiyet Ozkan
- Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ozlem Canoz
- Department of Pathology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Bulent Tokgoz
- Department of Nephrology, Erciyes University School of Medicine, Dede Efendi Street, Köşk District, Kayseri, Melikgazi, 38030, Turkey
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Meher D, Agarwal V, Prusty B, Das BK. Radiological images of osteitis fibrosa cystica and renal nephrolithiasis in a patient with pathological fracture due to severe primary hyperparathyroidism. BMJ Case Rep 2023; 16:e256873. [PMID: 37751974 PMCID: PMC10533665 DOI: 10.1136/bcr-2023-256873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Affiliation(s)
- Dayanidhi Meher
- Endocrinology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Vishal Agarwal
- Endocrinology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Binod Prusty
- Endocrinology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Bijay Ketan Das
- Endocrinology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
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3
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Vilanilam GK, Nikpanah M, Vo CD, Kearns C. Osteitis Fibrosa Cystica: Brown Tumors of Hyperparathyroidism and End-Stage Renal Disease. Radiographics 2023; 43:e220211. [PMID: 37079460 PMCID: PMC10190131 DOI: 10.1148/rg.220211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 04/21/2023]
Affiliation(s)
- George K. Vilanilam
- From the Department of Radiology, University of Arkansas for Medical
Sciences, 4301 W Markham St, Slot 556, Little Rock, AR 72205 (G.K.V.);
Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala,
and Radiology and Imaging Sciences, National Institutes of Health Clinical
Center, Bethesda, Md (M.N.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (C.D.V.); and Artibiotics,
Wellington, New Zealand, and Department of Radiology, Wellington Hospital, Te
Whatu Ora, Wellington, New Zealand (C.K.)
| | - Moozhan Nikpanah
- From the Department of Radiology, University of Arkansas for Medical
Sciences, 4301 W Markham St, Slot 556, Little Rock, AR 72205 (G.K.V.);
Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala,
and Radiology and Imaging Sciences, National Institutes of Health Clinical
Center, Bethesda, Md (M.N.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (C.D.V.); and Artibiotics,
Wellington, New Zealand, and Department of Radiology, Wellington Hospital, Te
Whatu Ora, Wellington, New Zealand (C.K.)
| | - Chau D. Vo
- From the Department of Radiology, University of Arkansas for Medical
Sciences, 4301 W Markham St, Slot 556, Little Rock, AR 72205 (G.K.V.);
Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala,
and Radiology and Imaging Sciences, National Institutes of Health Clinical
Center, Bethesda, Md (M.N.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (C.D.V.); and Artibiotics,
Wellington, New Zealand, and Department of Radiology, Wellington Hospital, Te
Whatu Ora, Wellington, New Zealand (C.K.)
| | - Ciléin Kearns
- From the Department of Radiology, University of Arkansas for Medical
Sciences, 4301 W Markham St, Slot 556, Little Rock, AR 72205 (G.K.V.);
Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala,
and Radiology and Imaging Sciences, National Institutes of Health Clinical
Center, Bethesda, Md (M.N.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (C.D.V.); and Artibiotics,
Wellington, New Zealand, and Department of Radiology, Wellington Hospital, Te
Whatu Ora, Wellington, New Zealand (C.K.)
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Yamaga E, Fujioka T, Asakage T, Miura K, Tateishi U. 18F-FDG-Detected Brown Tumor Confined to the Maxillary Bone With Parathyroid Adenoma. Clin Nucl Med 2022; 47:236-238. [PMID: 34560690 DOI: 10.1097/rlu.0000000000003897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Brown tumor is a reactive osteolytic lesion associated with hyperparathyroidism and an extremely rare form of a single lesion in the maxilla. We report the case of a 57-year-old woman with renal dysfunction, nasal obstruction, and hypercalcemia. MRI and CT revealed a huge osteolytic lesion in the maxilla. 18F-FDG PET/CT demonstrated marked FDG uptake within the mass and the lower-left lobe of the thyroid gland. 99mTc-methoxy-isobutyl-isonitrile scintigraphy suggested that this accumulation was a parathyroid adenoma. Parathyroid adenoma resection was performed, and the maxillary tumor was diagnosed as brown tumor. FDG PET/CT was helpful in evaluating brown tumor and detecting parathyroid adenoma.
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Affiliation(s)
- Emi Yamaga
- From the Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomoyuki Fujioka
- From the Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiro Asakage
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiko Miura
- Division of Surgical Pathology, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Ukihide Tateishi
- From the Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
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Facorat O, Fontaine C, Courtieu C, Trevillot V, Vidal C, Che H. Multiple Brown Tumors in Primary Hyperparathyroidism. J Clin Rheumatol 2021; 27:S766-S768. [PMID: 32732518 DOI: 10.1097/rhu.0000000000001504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | | | | | - Hélène Che
- From the Departments of Internal Medicine
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Rivas-Prado L, Morales-Ortega A, Allodi-de la Hoz S, Bernal-Bello D. Hyperparathyroidism shows its hand: findings of osteitis fibrosa cystica. Lancet 2021; 397:1914. [PMID: 34022989 DOI: 10.1016/s0140-6736(21)00796-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/26/2021] [Accepted: 03/30/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Luis Rivas-Prado
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain.
| | - Alejandro Morales-Ortega
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Sonia Allodi-de la Hoz
- Department of Radiology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - David Bernal-Bello
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
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Abstract
A 27-year-old man was called to receive a kidney transplant. The preoperative CT of the chest showed multiple osteolytic lesions, as well as a hypodense structure posterior in the right thyroid lobe. Blood analysis showed elevated parathyroid hormone, phosphorus, and alkaline phosphatase levels, with normal calcium and 25-OH-vitamin D. F-FDG PET/CT demonstrated generalized elevated FDG uptake in the bone (due to hyperparathyroidism), as well as multiple hypermetabolic focal lesions spread throughout the bone (fitting brown tumors). The nodule posterior of the right thyroid lobe showed an intense FDG uptake as well, suggestive of a parathyroid adenoma/hyperplasia. Histopathology confirmed the diagnosis.
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Affiliation(s)
- Astrid Geysen
- From the Division of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
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Castellano E, Attanasio R, Boriano A, Borretta V, Gennaro M, Latina A, Borretta G. Radiologic Manifestation of Bone Involvement in Primary Hyperparathyroidism: Prevalence and Clinical Significance in a Southern European Series. Endocr Pract 2020; 26:983-989. [PMID: 33471703 DOI: 10.4158/ep-2020-0095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/24/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Clinically overt symptomatic bone disease in primary hyperparathyroidism (PHPT) is rarely seen today, and osteoporosis is the dominant finding. Subperiosteal bone resorption in the fingers and skull mottling are typical bone PHPT findings, the contemporary prevalence of which is unknown. We evaluated these mild lesions and investigated the impact of their occurrence on PHPT clinical management. METHODS We evaluated retrospectively a monocentric series of 363 PHPT patients classified in Group 1 (n = 100) or Group 2 (n = 263) according to the presence or absence of bone involvement, respectively. Patients belonging to Group 1, in turn, were subdivided into Group 1A, with severe and symptomatic lesions (n = 48), and Group 1B, with milder signs of osteitis fibrosa cystica (OFC) without brown tumors or fractures (n = 52). RESULTS Serum total and ionized calcium, parathyroid hormone, osteocalcin, alkaline phosphatase, and its bone fraction levels were higher in Group 1 than in Group 2, while no gender or age differences were observed between the groups. Osteoporosis prevalence was similar in Group 1B and Group 2 patients but lower than in Group 1A. Mild OFC findings did not modify the surgical indication in any patient of Group 1B. CONCLUSION Minor radiologic signs of OFC are not uncommon in the modern PHPT phenotype and occur in patients with more active disease. These signs could identify PHPT patients in an earlier stage of typical bone involvement. However, these features do not seem to upgrade either the clinical classification of asymptomatic PHPT patients or the propensity toward surgical choice.
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Affiliation(s)
- Elena Castellano
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy.
| | - Roberto Attanasio
- Endocrinology Service, Galeazzi Orthopedic Institute IRCCS, Milan, Italy
| | - Alberto Boriano
- Medical Physics Department, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Valentina Borretta
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Marta Gennaro
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Adele Latina
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Giorgio Borretta
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
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Affiliation(s)
- Andre Ramon
- Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France
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10
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Hammou O, Azzouzi H, Ichchou L. Spinal Cοrd Compression Secondary to Brοwn Tumοr as First Manifestation of Primary Hyperparathyroidism. World Neurosurg 2020; 137:384-388. [PMID: 32105877 DOI: 10.1016/j.wneu.2020.02.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Brown tumors (BTs) represent the typical nonmalignant lesions of hyperparathyroidism. Mandibles, ribs, and large bones are the most usual localization of BT. The diagnosis of these tumors requires biological and radiologic assessments. Their treatment is essentially based on parathyroidectomy. CASE DESCRIPTION The present case report describes a patient with primary hyperparathyroidism who developed a cervical BT revealed by slow spinal compression. CONCLUSIONS The brown tumor, when localized at the level of the spine, can be life-threatening and must be managed as soon as possible.
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Affiliation(s)
- Ouafae Hammou
- Department of Rheumatology, Mohammed VI University Hospital, Mohammed I University, Oujda, Morocco.
| | - Hamida Azzouzi
- Department of Rheumatology, Mohammed VI University Hospital, Mohammed I University, Oujda, Morocco
| | - Linda Ichchou
- Department of Rheumatology, Mohammed VI University Hospital, Mohammed I University, Oujda, Morocco
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11
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Govindu R, Ammar H. Thoracic Deformity and Acro-Osteolysis in Severe Renal Osteodystrophy. Mayo Clin Proc 2019; 94:2358-2359. [PMID: 31685157 DOI: 10.1016/j.mayocp.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 08/05/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Rukma Govindu
- University of Texas Health Science Center at Houston, Houston, TX.
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Eroglu E, Kontas ME, Kocyigit I, Kontas O, Donmez H, Kucuk A, Sipahioglu MH, Tokgoz B, Oymak O. Brown tumor of the thoracic spine presenting with paraplegia in a patient with peritoneal dialysis. CEN Case Rep 2019; 8:227-232. [PMID: 31089951 DOI: 10.1007/s13730-019-00398-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 04/18/2019] [Indexed: 11/26/2022] Open
Abstract
Secondary and tertiary hyperparathyroidism is an important problem of chronic kidney disease. Brown tumor is a benign, unusual, reactive lesion as a result of disturbed bone remodeling, from long-standing increase in parathyroid hormone level. Brown tumors may cause morbidity due to pressure symptoms on neural structures and spontaneous bone fractures. Herein, we presented a peritoneal dialysis patient with tertiary hyperparathyroidism under calcand calcitriol treatment for 4 years due to refusing of the parathyroidectomy operation. She admitted to hospital for sudden onset back pain with difficulty in gait and walking, and imaging studies showed an expansile mass lesion in the thoracic spine. She was operated for mass and diagnosed with brown tumor. After operation, she lost the ability of walking than become paraplegic and she underwent rehabilitation program. Preventive measures including calcitriol and cinacalcet may cause a modest decrease in parathyroid hormone levels but it should be remembered for the development of bone complications such as brown tumor formation in patients with moderate elevated PTH levels, especially those with tertiary hyperparathyroidism. Parathyroidectomy should be performed without delay in these cases.
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Affiliation(s)
- Eray Eroglu
- Division of Nephrology, Department of Internal Medicine, Erciyes University Medical Faculty, 38039, Kayseri, Turkey.
| | - Mustafa Eymen Kontas
- Department of Internal Medicine, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Ismail Kocyigit
- Division of Nephrology, Department of Internal Medicine, Erciyes University Medical Faculty, 38039, Kayseri, Turkey
| | - Olgun Kontas
- Department of Pathology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Halil Donmez
- Department of Radiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Ahmet Kucuk
- Department of Neurosurgery, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Murat Hayri Sipahioglu
- Division of Nephrology, Department of Internal Medicine, Erciyes University Medical Faculty, 38039, Kayseri, Turkey
| | - Bulent Tokgoz
- Division of Nephrology, Department of Internal Medicine, Erciyes University Medical Faculty, 38039, Kayseri, Turkey
| | - Oktay Oymak
- Division of Nephrology, Department of Internal Medicine, Erciyes University Medical Faculty, 38039, Kayseri, Turkey
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13
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Misiorowski W, Czajka-Oraniec I, Kochman M, Zgliczyński W, Bilezikian JP. Osteitis fibrosa cystica-a forgotten radiological feature of primary hyperparathyroidism. Endocrine 2017; 58:380-385. [PMID: 28900835 PMCID: PMC5671544 DOI: 10.1007/s12020-017-1414-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/08/2017] [Indexed: 12/27/2022]
Abstract
UNLABELLED Although bone disease and stone disease are the universally accepted classical manifestations of primary hyperparathyroidism, clinical parathyroid bone disease is rarely seen today in the United States (<5% of patients) and Western Europe. Nevertheless, in a given patient, classical skeletal involvement can be the first sign of primary hyperparathyroidism, but not recognized because it is not usually included, anymore, in the differential diagnosis of this manifestation of skeletal disease. We describe four cases of primary hyperparathyroidism in which the first clinical manifestation of the disease was a pathological fracture that masqueraded as a malignancy. The presence of large osteolytic lesions gave rise to the initial diagnosis of a primary or metastatic cancer. In none of the reported cases was primary hyperparathyroidism with osteitis fibrosa considered as the diagnosis. It would seem to us that this course is best explained by the fact that in many countries such manifestations of primary hyperparathyroidism have become a rarity. In fact, the incidence of osteitis fibrosa among patients with primary hyperparathyroidism in the US is estimated as so rare, that in majority of medical centers routine x-ray examinations of the bones in these patients is not recommended. The X-ray or computed tomography scan findings of osteitis fibrosa cystica include lytic or multilobular cystic changes. Multiple bony lesions representing brown tumors may be misdiagnosed on computed tomography scan as metastatic carcinoma, bone cysts, osteosarcoma, and especially giant-cell tumor. Distinguishing between primary hyperparathyroidism and malignancy is made readily by the concomitant measurement of parathyroid hormone which in primary hyperparathyroidism, again, will be markedly elevated. In the hypercalcemias of malignancy, such elevations of parathyroid hormone are virtually never seen. CONCLUSION When radiographic evidence of a lytic lesion and hypercalcemia are present, primary hyperparathyroidism should always be considered in the differential diagnosis.
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Affiliation(s)
- Waldemar Misiorowski
- Endocrinology Dept, Medical Center for Postgraduate Education, Bielanski Hosp., Ceglowska 80 str., 01-809, Warsaw, Poland.
| | - Izabela Czajka-Oraniec
- Endocrinology Dept, Medical Center for Postgraduate Education, Bielanski Hosp., Ceglowska 80 str., 01-809, Warsaw, Poland
| | - Magdalena Kochman
- Endocrinology Dept, Medical Center for Postgraduate Education, Bielanski Hosp., Ceglowska 80 str., 01-809, Warsaw, Poland
| | - Wojciech Zgliczyński
- Endocrinology Dept, Medical Center for Postgraduate Education, Bielanski Hosp., Ceglowska 80 str., 01-809, Warsaw, Poland
| | - John P Bilezikian
- Department of Medicine, Endocrinology Division, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Queiroz IV, Queiroz SP, Medeiros R, Ribeiro RB, Crusoé-Rebello IM, Leão JC. Brown tumor of secondary hyperparathyroidism: surgical approach and clinical outcome. Oral Maxillofac Surg 2016; 20:435-439. [PMID: 27640197 DOI: 10.1007/s10006-016-0575-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/05/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Secondary hyperparathyroidism is a frequent complication of chronic renal failure. The brown tumor is an unusual presentation of fibrous osteitis that represents a serious complication of renal osteodystrophy, affecting predominantly the hands, feet, skull, and facial bones. CASE REPORT The aim of this paper is to describe the case of a 53-year-old female patient, with renal failure who has been on dialysis for 6 years and developed severe secondary hyperparathyroidism and brown tumor of the maxilla and mandible, confirmed by incisional biopsy. Parathyroidectomy was indicated as a result of rapid growth of the tumor and the maintenance of laboratory findings. Despite the normalization of serum parathyroid hormone and alkaline phosphatase, tumor regression was slow and patient's important functional and esthetic deficits persisted. Excision of the mandible tumor was conservative. Osteoplasty was recommended because during a 5-year follow-up there was regression of the lesion, decreased pain, bleeding, and tooth mobility.
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Affiliation(s)
| | | | - Rui Medeiros
- Federal University of Pernambuco, Recife, Brazil
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15
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Salamone D, Muresan S, Muresan M, Neagoe R. Multilevel brown tumors of the spine in a patient with severe secondary hyperparathyroidism A case report and review of the literature. Ann Ital Chir 2016; 87:S2239253X16024749. [PMID: 27064191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The brown tumour is an extreme form of osteitis fibrosa cystica, representing a serious complication of the advanced primary or secondary hyperparathyroidism. It occurs in settings of high levels parathyroid hormone, like in primary or secondary hyperparathyroidism, with a frequency of 3-4% and 1.5-13% respectively, usually affecting young people. CASE REPORT The authors report a case of a 45 years old woman on long-term hemodialysis, with severe secondary hyperparathyroidism. The main clinical complaints were neck pain, lower thoraco-lumbar back pain, persistent left groin pain, and bilateral lower extremities weakness. The computed tomography scan revealed multiple spine brown tumors affecting the cervical, thoracic and lumbar level. After an initial partial response to the treatment of two years with Cinacalcet, a deterioration of the secondary hyperparathyroidism occurred (hypercalcemia, hyperphosphatemia) and the patient was referred for parathyroidectomy. The patient underwent total parathyroidectomy with auto-transplantation, with a positive postoperative result. CONCLUSIONS Secondary hyperparathyroidism can lead, during its course, to osteolytic bone lesions called brown tumors. If the medical treatment fails, the surgical removal of the parathyroid glands with autotransplant remains the only treatment of the bone lesions progression. Reviewing the relevant literature in English (until March 2015), we found 24 cases of symptomatic vertebral brown tumors. To the authors' knowledge, this is the first case which describes a multilevel spine involvement (more than two), and the fifth describing a cervical localization. KEY WORDS Hypocalcaemia, Secondary hyperparathyroidism, Spine brown tumors.
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16
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Seo D, Rhee Y. Osteitis fibrosa cystica in primary hyperparathyroidism. QJM 2015; 108:991. [PMID: 26261355 DOI: 10.1093/qjmed/hcv144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- D Seo
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Y Rhee
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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17
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Affiliation(s)
- René Rodríguez-Gutiérrez
- Department of Internal Medicine, Endocrinology Division, University Hospital "Dr. José E. González" Universidad Autónoma de Nuevo León, Monterrey, Mexico.
| | - José Miguel Hinojosa-Amaya
- Department of Internal Medicine, Endocrinology Division, University Hospital "Dr. José E. González" Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Abstract
A 79-year-old woman presents with left anterior knee pain after a fall.
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19
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Affiliation(s)
- Tom Rider
- Royal Sussex County Hospital, Brighton BN2 5BE, UK
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Qian ZH, Bai RJ, Yan D, Li XM, Cheng XG, Gu X, Qu H. [Skeletal disease in primary hyperparathyroidism: X-ray, CT and MR imaging founding]. Zhonghua Yi Xue Za Zhi 2013; 93:30-33. [PMID: 23578450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To analyze the X-ray, CT and MR imaging findings in skeletal disease with primary hyperparathyroidism (PHPT), so as to discuss the clinic feature and differential diagnosis. METHODS Thirty patients with PHPT were confirmed by surgery and pathological examination. In 15 patients the lesion were found in femur. There were 15 tibia, 12 fibula, and 14 iliac lesions. In three patients lesions were found in vertebrae. Three patients had lesions in humeri. In five patients lesions were found in rib. Twelve patients had lesions in phalanges. Thirty patients were studied preoperatively with radiographs, CT and MR imaging. The imaging findings were compared with the pathologic diagnosis and confirmed by double blind method. RESULTS Radiographs of the bone in 30 patients showed generalised osteopaenia. There were 20 (66.7%) cases with bone resorption, which include 12 (40.0%) cases with subperiosteal resorption, 11 (36.7%) cases with cortical bone resorption, and 10 (33.3%) cases with subchondral resorption. There were 19 (63.3%) cases with osteitis fibrosa cystica/brown tumor. There were 5 (16.7%) patients sustained a pathological fracture. CONCLUSION X-ray, CT and MR imaging founding reflect the imaging and pathology features in skeletal disease of PHPT. The iliac lesions could been found in common, and usually eroding sacroiliac joint. Skeletal disease of PHPT should be differentiated from osteolytic metastatic tumor of bone, osteodysplasia fibrosa, giant cell tumor of bone and aneurysmal bone cysts.
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Affiliation(s)
- Zhan-hua Qian
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
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21
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van Asseldonk EJP, de Sévaux RGL, Flucke UE, de Rooy JWJ, Netea-Maier RT, Timmers HJLM. Multiple osteolytic bone lesions. Neth J Med 2011; 69:399-403. [PMID: 21978984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- E J P van Asseldonk
- Department of Endocrinology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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22
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Admassie D, kebede T, Feleke Y. Brown tumor an uncommon and late manifestation of hyperparathyroidism: a case series done at Tikur Anbessa Specialized Hospital, Addis Ababa. Ethiop Med J 2011; 49:149-153. [PMID: 21796915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Brown tumor of hyperparathyroidism is a non-neoplastic osteoclastic process which results in cystic lesions that are often expansile. It occurs rarely and is often a late manifestation of primary hyperparathyroidism (PHPT). Multiple bone involvement is extremely rare. Because of its resemblance with benign tumors if it occurs as a solitary bone lesion and of metastatic bone lesion when it is multiple, differentiation is often difficult without biochemical analysis. Here we presented eight patients who visited Tikur Anbessa Specialized Hospital for the last 15 years with primary skeletal complaints. Out of these six were females and except one patient all had multiple brown tumors. Based on radiographic features only it is often difficult to diagnose the condition and biochemical tests and anterior neck sonography is usually crucial to reach at a definitive diagnosis. Although the occurrence of more than one separate bone lesion in the skeleton usually suggests metastasis, our cases shows that brown tumors should also be included in the differential diagnosis of such lesions, particularly in patients with hyperparathyroidism.
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Affiliation(s)
- Daniel Admassie
- Department of Radiology, School of Medicine, College of Health Sciences, Addis Ababa University
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23
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Lacativa PGS, Franco FM, Pimentel JR, Patrício Filho PJDM, Gonçalves MDDC, Farias MLF. Prevalence of radiological findings among cases of severe secondary hyperparathyroidism. SAO PAULO MED J 2009; 127:71-7. [PMID: 19597681 PMCID: PMC10964801 DOI: 10.1590/s1516-31802009000200004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 01/22/2009] [Accepted: 03/17/2009] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Patients with end stage renal disease (ESRD) and secondary hyperparathyroidism (HPT2) are prone to develop heterotopic calcifications and severe bone disease. Determination of the sites most commonly affected would decrease costs and patients' exposure to X-ray radiation. The aim here was to determine which skeletal sites produce most radiographic findings, in order to evaluate hemodialysis patients with HPT2, and to describe the most prevalent radiographic findings. DESIGN AND SETTING This study was cross-sectional, conducted in one center, the Hospital Universitário Clementino Fraga Filho (HUCFF), in Rio de Janeiro, Brazil. METHODS Whole-body radiographs were obtained from 73 chronic hemodialysis patients with indications for parathyroidectomy due to severe HPT2. The regions studied were the skull, hands, wrists, clavicles, thoracic and lumbar column, long bones and pelvis. All the radiographs were analyzed by the same two radiologists, with great experience in bone disease interpretation. RESULTS The most common abnormality was subperiosteal bone resorption, mostly at the phalanges and distal clavicles (94% of patients, each). 'Rugger jersey spine' sign was found in 27%. Pathological fractures and deformities were seen in 27% and 33%, respectively. Calcifications were presented in 80%, mostly at the forearm fistula (42%), abdominal aorta and lower limb arteries (35% each). Brown tumors were present in 37% of the patients, mostly on the face and lower limbs (9% each). CONCLUSION The greatest prevalence of bone findings were found on radiographs of the hands, wrists, lateral view of the thoracic and lumbar columns and femurs. The most prevalent findings were bone resorption and ectopic calcifications.
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Affiliation(s)
- Paulo Gustavo Sampaio Lacativa
- Endocrinology Service, Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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24
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Aragón Valera C, Carrasco de la Fuente M, Alpañés Buesa M, Sanchón Rodríguez R, Antón Bravo T, de la Calle Blasco H. [Osteitis fibrosa cystica as the initial manifestation of primary hyperparathyroidism]. Endocrinol Nutr 2009; 56:140-142. [PMID: 19627728 DOI: 10.1016/s1575-0922(09)70845-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 11/24/2008] [Indexed: 05/28/2023]
Abstract
Primary hyperparathyroidism is a common endocrinological disease and most cases are asymptomatic. We report the case of a patient with primary hyperparathyroidism and symptomatic bone lesions. The possibility of different etiologies (adenoma vs carcinoma) according to the clinical manifestations and treatment are also discussed.
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25
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Mansour M, Kessler HP, Angevine T. AAOMP case challenge: bilateral multi-locular radiolucent lesions of the mandible. J Contemp Dent Pract 2009; 10:98-102. [PMID: 19142262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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26
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Meydan N, Barutca S, Guney E, Boylu S, Savk O, Culhaci N, Ayhan M. Brown tumors mimicking bone metastases. J Natl Med Assoc 2006; 98:950-3. [PMID: 16775919 PMCID: PMC2569361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Brown tumors are rare skeletal manifestations of hyperparathyroidism (HPT) that may mimic cancer metastasis. Here, we present a 52-year-old woman with HPT and multiple foci of technetium uptake due to brown tumors on bone scintigraphy. Screening tests were negative for cancer and serum parathormon (PTH) measurement; parathyroid ultrasonography and scintigraphy suggested HPT. A chief cell adenoma in right and hyperplasia in the left parathyroid glands were surgically removed after which hungry bone syndrome emerged. Biopsy of the femur lesion during an open reduction with fixation operation due to a fracture established the diagnosis of a brown tumor. Brown tumors are important to consider in the evaluation of patients presenting with multiple foci of uptake on bone scanning and without an established primary neoplasm.
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Affiliation(s)
- Nezih Meydan
- Department of Internal Medicine Adnan Menderes University Medical School, Aydin, Turkey.
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27
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Pianou N, Housianakou I, Papathanasiou N, Karampina P, Giannopoulou C. [Brown tumors in the technetium-99m methyldiphosphonate bone scan mimicking metastases of parathyroid carcinoma]. Hell J Nucl Med 2006; 9:146-8. [PMID: 16894425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Accepted: 07/10/2006] [Indexed: 05/11/2023]
Abstract
This is a case of a 78 year old male with parathyroid carcinoma and multiple bone lesions in the technetium-99m methyldiphosphonate ((99m)Tc-MDP) bone scan, initially interpreted as metastatic bone disease, but finally proved to be brown tumors. The interest of this case lies on the rarity of the disease, as well as the co-existence of osteitis fibrosa cystica, which often resembles metastatic bone disease and leads to diagnostic pitfalls.
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Affiliation(s)
- Nicoletta Pianou
- Nuclear Medicine Department, "Evangelismos" Hospital, 45-47 Ypsilantou Str., 10676 Athens, Greece.
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28
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Zietek P, Bohatyrewicz A, Kotrych D, Jakuszewski M, Gusta A. [Imitation of metastatic lesions in patients with brown tumor]. Chir Narzadow Ruchu Ortop Pol 2006; 71:459-61. [PMID: 17585490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The authors have presented two cases of hyperparathyroidism in male patients at the age of 52 and 77 years in whom radiological findings imitated osteolytic, metastatic bone lesions. It has been emphasised that the difficulties with proper diagnosis of brown tumor often occur and the final diagnosis is based on the exact pathology test. In patients with pathological fracture resection with margins and intramedullary fixation, as well as total hip replacement were performed. Postoperative observation revealed that the pain and radiological changes stopped after parathyroid gland resection as the main reason of the brown tumor. The authors have confirmed that open biopsy should be a routine procedure in patients with suspicion of brown tumor.
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Affiliation(s)
- Paweł Zietek
- Katedra i Klinika Ortopedii i Traumatologii i Pomorska Akademia Medyczna w Szczecinie
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Erturk E, Keskin M, Ersoy C, Kaleli T, Imamoglu S, Filiz G. Metacarpal brown tumor in secondary hyperparathyroidism due to vitamin-D deficiency. A case report. J Bone Joint Surg Am 2005; 87:1363-6. [PMID: 15930550 DOI: 10.2106/jbjs.d.02250] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Erdinc Erturk
- Department of Endocrinology, Uludag University School of Medicine, Gorukle 16059 Bursa, Turkey.
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31
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Abstract
A case report where parathyroid bone disease simulates bone metastases. Subsequent treatment of underlying hyperparathyroidism causes a marked improvement in bone disease, leading to a review of the initial diagnosis.
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Affiliation(s)
- C J Sugden
- Palliative Medicine, St Andrews Hospice, Airdrie, UK
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32
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Abstract
A 32-year-old woman sustained a minor sliding accident with moderate to severe pain about the left distal thigh and hip and the right shoulder. Radiographs showed marked osteopenia, multiple osteolytic bone lesions, and a pathologic fracture of the left distal femur. Surgical intervention was conducted for the pathologic fracture, and the pathological findings confirmed the diagnosis of primary hyperparathyroidism with osteitis fibrosa cystica. We report this rare case here because it may be mistaken for neoplastic metastatic disease on radiographs and bone scan. The pathologic fracture usually heals and the bone mineral density improves significantly within 6 months after parathyroidectomy.
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Affiliation(s)
- Ming-Chun Hsieh
- Department of Emergency and Trauma Surgery, Chang Gung Memorial Hospital at Kaohsiung, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung, Taiwan, Republic of China.
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33
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Safi S, Hassikou H, Messary A, Boumdin H, Hadri L, Zouhair A. [Severe primary hyperparathyroidism and vitamin D deficiency]. Ann Endocrinol (Paris) 2004; 65:226-32. [PMID: 15277981 DOI: 10.1016/s0003-4266(04)95677-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Primary hyperparathyrodism is a common disease, often asymptomatic. A young post-partum woman was hospitalized for functional impotence of the upper right limb and poor health status. Laboratory tests revealed severe primary hyperparathyroidism (osteitis fibrosa cystica and nephrolithiasis) associated with vitamin D deficiency. Technetium 99m and thallium parathyroid scintigraphy showed increased uptake under the left thyroid lobe. After surgical resection of a parathyroid adenoma, serum calcium fell markedly and parathyroid levels declined but remained above normal. Calcium and 25(OH)-vitamin D supplementation led to normal calcium and vitamin D levels in three Months, with marked improvement in the bone lesions visualized on the six-Month x-rays. Based on this observation, we describe the many radiological aspects of bone involvement in long-standing hyperparathyroidism aggravated by vitamin D deficiency. Early diagnosis of hyperparathyroidism is crucial.
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Affiliation(s)
- S Safi
- Service de médecin interne, hôpital militaire Moulay Ismaïl, Meknès.
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Abstract
Renal osteodystrophy, characterized by uneven bone growth and demineralization, is described. Oral manifestations of the disorder are described, and the value of dental radiographs in early detection of renal osteodystrophy is noted. A case report of a patient with severe oral complications, which resulted from long-standing end-stage renal disease and secondary hyperparathyroidism, is presented. Giant cell lesions of hyperparathyroidism, referred to as brown tumors (which may be associated with pain and swelling), are the key clinical oral manifestations and are the most dramatic dental radiographic finding in patients with renal osteodystrophy. Bone changes may include loss of lamina dura, giant cell lesions of hyperparathyroidism, and bone demineralization. The dentist's role in detection, assessment, and treatment is stressed.
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Affiliation(s)
- John R Antonelli
- Department of Prosthodontics, Nova Southeastern University, Health Professions Division, College of Dental Medicine, 3200 South University Drive, Fort Lauderdale, FL 33328-2018, USA.
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35
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Abstract
Brown tumor of the larynx is extremely rare. We describe a patient with long-standing primary hyperparathyroidism and severe skeletal involvement associated with brown tumors of the axial and appendicular skeleton and of the thyroid cartilage. Ossification of the laryngeal skeleton may explain the presence of this process in this unusual location.
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Affiliation(s)
- Jacques Perrin
- Department of Radiology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
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36
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Koudela K, Koudelová J, Kreuzberg B, Treska V, Kinkor Z, Koudela K. [Primary hyperparathyroidism (osteitis fibrosa cystica generalisata Recklinghausen)]. Acta Chir Orthop Traumatol Cech 2003; 70:377-82. [PMID: 15002355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The case of a 67-year-old man presenting with parathyroid gland adenoma associated with multiple organ manifestations of a rare normocalcemic form of primary hyperparathyroidism is described. The authors draw attention to the importance of correlating clinical and laboratory examinations with histological, radiological and scintigraphic findings for the establishment of diagnosis. They emphasize the role of two-phase 99mTC-MIBI (methoxyisobutyl-isonitril) scintigraphy not only for diagnostic purposes but also for exact localization of the adenoma by means of a gamma probe during surgery. They also point out the possibility of accompanying pathological conditions, in this case, the development of a tumor described as "brown tumor". This was shown by angiography as a hypervascularized and strongly stained expanding lesion. The authors conclude that the early surgical removal of this parathyroid gland adenoma was important for the patient's successful recovery.
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Affiliation(s)
- K Koudela
- Klinika ortopedie a traumatologie pohybového ústrojí LFUK a FN, Plzen.
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37
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Agarwal G, Mishra SK, Kar DK, Singh AK, Arya V, Gupta SK, Mithal A. Recovery pattern of patients with osteitis fibrosa cystica in primary hyperparathyroidism after successful parathyroidectomy. Surgery 2002; 132:1075-83; discussion 1083-5. [PMID: 12490858 DOI: 10.1067/msy.2002.128484] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND After parathyroidectomy, recovery of osteitis fibrosa cystica, which continues to dominate presentation of primary hyperparathyroidism in India has not been documented objectively. METHODS We followed up clinical recovery, biochemic markers of bone turnover, bone mineral density, and skeletal radiology in 51 patients with primary hyperparathyroidism and osteitis fibrosa cystica for 9 to 124 months (median, 32 months). RESULTS After parathyroidectomy, 46 patients had hypocalcemia. During postoperative week 1, bone pain improved in 71%. During 3 months, appendicular fractures healed in all 33 such patients, and 6 of 7 patients who were bedridden could walk. Mean bone mineral density increments (percent change/y) seen at various sites at 1 week, 3, 6, and 12 months were distal forearm--37, 28, 23, 21; lumbar spine--165, 104, 101, 106; and total hip--168, 157, 166, 133. Follow-up radiographs demonstrated prompt recovery though disorderly remineralization. Brown tumors and fractures showed hyperdensities within 3 months. Brown tumors regressed partially in 6 of 27 patients after 6 months. CONCLUSIONS After parathyroidectomy, patients with primary hyperparathyroidism have early, marked, and sustained recovery of osteitis fibrosa cystica. Early (1 week) bone mineral density increments of > 100%/y hint at the skeleton's ability to promptly restore itself. Densitometric recovery is prompt at cancellous (lumbar spine), but not at cortical (forearm) bone sites. Contour defects and bony tumors persist, and may need corrective osteotomies.
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Affiliation(s)
- Gaurav Agarwal
- Department of Endocrine Surgery, Endocrine Sciences Centre, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, India
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Abstract
We report the 6-year radiographic follow-up of a phalangeal brown tumor in a patient with severe hyperparathyroidism secondary to chronic renal failure treated with hemodialysis. The phalangeal lesion increased in size during the first 3 years, until the patient finally accepted to undergo parathyroidectomy. The initial radiographic change was a small intracortical lytic area. Two years later, an expansile cystic lesion was visible in the phalanx, and computed tomography showed a cortical defect. Ossification of the lesion occurred over the 2.5 years following parathyroidectomy. The epidemiology, radiographic changes and post-treatment evolution of brown tumor in dialysed patients is reviewed. Surgical parathyroidectomy is the standard treatment for brown tumor complicating secondary hyperparathyroidism. The usefulness and limitations of treatment with vitamin D analogs, recently reported in a few case reports, are discussed.
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Affiliation(s)
- M Franco
- Nephrology Department, Hĵpital Pasteur, 30, avenue de la Voie Romaine, 06202 Nice cedex 1, France.
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39
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Collins WO, Buchman CA. Radiology quiz case 2: metastatic calcifications of the middle and external ear and osteitis fibrosa of the temporal bones as a result of secondary hyperparathyroidism. Arch Otolaryngol Head Neck Surg 2002; 128:457, 459-60. [PMID: 11926927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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40
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Saario R, Viikari J, Mattila K, Airio A. [All bone nodules are not caused by osteoarthritis or rheumatoid arthritis]. Duodecim 2002; 114:1487-90. [PMID: 11552237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- R Saario
- TYKS:n sisätautien klinikka, 20520 Turku
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41
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Affiliation(s)
- M R Rubin
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA
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42
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D'Avanzo A, Parangi S, Morita E, Perrier ND, Wu HS, Siperstein AE, Duh QY, Treseler PA, Clark OH. False positive 99mTc sestamibi scans in patients with osteitis fibrosa cystica and brown tumours. Eur J Surg 2001; 167:592-7. [PMID: 11716445 DOI: 10.1080/110241501753171191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- A D'Avanzo
- Endocrine Surgical Fellow, UCSF and Federico II University of Naples, Italy
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43
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Rivero Marcotegui M, José Unzué Gaztelu J, Caballero García P. [Osteitis fibrosa cystica]. Med Clin (Barc) 2001; 116:320. [PMID: 11333759 DOI: 10.1016/s0025-7753(01)71814-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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44
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Yamaguchi T. Images in haematology. Osteitis fibrosa cystica generalisata with adult T-cell leukaemia: a case report. Br J Haematol 2000; 110:757. [PMID: 11054056 DOI: 10.1046/j.1365-2141.2000.02223.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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45
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Tripi TR, Bonaccorso A, Sortino F. [Von Recklinghausen osteitis fibrosa cystica. A clinical case]. Minerva Stomatol 1999; 48:283-8. [PMID: 10522398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
In Recklinghausen's disease the skeleton lesions are often the first signal of the pathology. The main clinical manifestations are represented by bony lesions which appear as multicystic lesions with loss of the hard lamina and skull malformation and asymmetry. In this disease there is a relevant osteoclastic activity which prevails over the osteoblastic one associated to the fibrous substitution of the marrow, sometimes producing micro or macro cysts. The typical alteration consists of an increase along the endosteal and trabecular surfaces in the number of osteoclasts which can be found in small reabsorption gaps. This is the cause of a cortical and trabecular reduction which can appear as interrupted. Histologic lesions consist in the replacement of bone tissue with fibrous and osteoid tissue. These bony lesions are not characteristic of the disease but to be distinguished from other pathologies such as for example Paget's disease and other forms of fibrous dysplasia (Gardner's syndrome, Leontiasis ossea). A case personally observed is described: a women, 29 years old, suffering from Recklinghausen's disease with face and skull asymmetry, condyles and glenoid cavity deformation, abnormal face reduction. Observing the planigraphy on the right side of the temporomandibular articulation, flattened glenoid cavity and condyles with irregular outlines can be noticed, aplastic coronoid cuts, altered jaw. The patient was submitted to surgery for dental extraction followed by a biopsy which showed some regressive alterations on cellular level of the bony structure.
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Affiliation(s)
- T R Tripi
- Istituto di I Clinica Odontoiatrica, Università degli Studi, Catania
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46
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Meldahl I, Ljungström KG, Wickerts CJ, Von Sivers K. [Fulminant acute pancreatitis caused by a large parathyroid adenoma. Hyperparathyroidism was diagnosed after 5 years]. Lakartidningen 1999; 96:2603-6. [PMID: 10388282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Abstract
An unusual case of multiple brown tumors due to parathyroid carcinoma is reported. The patient presented with lower leg pain. Plain radiographs demonstrated multiple lytic lesions of the lower legs and a Tc-99m MDP bone scan depicted multiple areas of increased uptake suggesting skeletal metastases. Tc-99m sestamibi tumor scintigraphy showed multiple sites of tumor uptake in bones and a large area of increased uptake with a cystic component in the right lower pole of the thyroid gland. An open biopsy from the right tibial lesion revealed a brown tumor. A large parathyroid carcinoma with a necrotic cyst was removed. After parathyroidectomy and right thyroid lobectomy, the patient became free of bone pain and serum PTH levels normalized. A 9-month follow-up Tc-99m MDP bone scan demonstrated less intense uptake in the pelvis, tibia, and fibulae. Nine-month follow-up tumor imaging with Tc-99m MIBI revealed disappearance of the preoperative uptake of multiple brown tumor.
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Affiliation(s)
- M Pai
- Department of Nuclear Medicine, Ajou University Hospital, Suwon, Korea
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Affiliation(s)
- C M Spaulding
- Department of Veterans Affairs Medical Canter, Doxey-Hatch Medical Center, University of Utah, Salt Lake City, USA
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Floareş G, Zbranca E, Creţu A, Cernomaz O. [A rare form of osteopoikilosis]. Rev Med Chir Soc Med Nat Iasi 1997; 101:209-12. [PMID: 10756757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The authors report a typical case of osteopoikilosis striata Voorhoeve in a 51-years-old female. In connection with case they make some consideration concerning the diagnostic of this very infrequent sclerotic bone dysplasia.
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Affiliation(s)
- G Floareş
- Facultatea de Medicină, Universitatea de Medicină şi Farmacie Gr. T. Popa, Iaşi
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Abstract
A 24-year-old man with primary hyperparathyroidism and osteitis fibrosa cystica developed acute hypocalcaemia. Spontaneous healing of his bone disease was confirmed radiographically and by correction of the serum alkaline phosphatase. Hypercalcaemia associated with a raised serum parathyroid hormone recurred 90 weeks after the initial presentation. During the fourth neck exploration a parathyroid adenoma was removed, resulting in resolution of his condition. Haemorrhagic infarction of an adenoma was the most likely cause of the acute hypocalcaemic episode.
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Affiliation(s)
- C J Gibbs
- Department of Endocrine Medicine, Southampton University, Portsmouth, UK
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