An unusual presentation of primary hyperparathyroidism: Severe hypercalcemia and multiple brown tumors (original) (raw)
Related papers
Brown tumors: an uncommon manifestation of bone disease in primary hyperparathyroidism
DOAJ (DOAJ: Directory of Open Access Journals), 2019
Bone involvement in primary hyperparathyroidism (PHPT) is characterized by decreased bone mineral density, bone resorption at both trabecular and cortical sites and bone erosions, up to brown tumors (BT) and cysts, the so-called osteitis fibrosa cystica (OFC). Signs and symptoms of OFC include bone pain, muscle weakness, skeletal deformities and pathological fractures. In recent years, PHPT has greatly changed its clinical expression, especially in Western countries. For these reason BT, a typical expression of OFC, are always less observed and often mistaken for malignancy. An integrated diagnostic approach, considering first a complete biochemical panel and a confirmation by functional imaging, is crucial for a correct diagnosis, mostly considering that such skeletal manifestations may be reversible after surgical cure of PHPT.
Primary Hyperparathyroidism With Brown Tumor Mimicking Metastatic Bone Malignancy
Journal of the Chinese Medical Association, 2010
Bone and joint pain are commonly encountered conditions in daily practice. In the elderly, when osteolytic lesions are identified in imaging studies, metastatic bone tumor is the first impression that comes to the clinician's mind. Although the worst-case scenario should be ruled in, other differential diagnoses such as metabolic bone disease should be considered as well. We report a case of brown tumor caused by parathyroid adenoma. The patient had initial presentation of diffuse bone pain and multiple osteolytic lesions on imaging studies similar to metastatic bone tumor. With a systematic approach and awareness of metabolic bone disease, an accurate diagnosis was finally reached. Appropriate treatments, including preventive internal fixation of the impending femoral fracture and surgical excision of the parathyroid adenoma were performed accordingly. The key treatment for the condition was surgical excision of the parathyroid adenoma. After normalization of serum intact-parathyroid hormone level, the bony lesions resolved and required no further orthopedic surgery. The patient is now symptom-free. In addition to suspecting malignancy, the clinician should be highly alert to other possible causes of bony lesions. Brown tumor should be kept in mind during daily practice. [J Chin Med Assoc 2010;73(3):177-180]
Primary hyperparathyroidism having multiple Brown tumors mimicking malignancy
Indian Journal of Endocrinology and Metabolism, 2012
Primary hyperparathyroidism is a disease characterized by excessive secretion of parathormone. During the course of this disease, bone loss occurs, particularly depending on resorption of the skeletal system. One of the complications of primary hyperparathyroidism is fi brotic, cystic bony changes which is called Brown tumor. Skeletal manifestations in the form of Brown tumors are rare and according to literature occur in less than 2% of patients suffering from any form of hyperparathyroidism. Such rare and multiple benign lesions may simulate a malignant neoplasm and pose a real challenge for the clinician in its differential diagnosis. We present a case of a 23-year-old Indian woman who was evaluated for multiple lytic expansile lesions with a strong suspicion of malignancy and fi brous dysplasia but turned out to be a case of primary hyperparathyroidism.
Tertiary hyperparathyroidism with multiple Brown tumors mimicking malignancy
Scholars Academic Journal of Biosciences, 2016
Brown tumors are an uncommon type of benign osteolytic bone lesions that occur in hyperparathyroidism, which is an endocrine disease characterized by excessive secretion of the hormone parathormone. They occur more in primary hyperparathyroidism and are seen to regress after removal of parathyroid adenomas. In our report, we describe a a case of tertiary hyperparathyroidism with multiple lytic lesions of the right great toe, left fibula, twelfth posterior rib on right side and base of middle phalanx of left hand. This report illustrates the importance of taking brown tumor in differential diagnosis in patients with multiple lytic lesions, occurring in the backdrop of chronic kidney disease, where a failure to establish an accurate diagnosis may lead to further unnecessary and painful diagnostic procedures and even extensive surgery.
Diagnostic dilemma: metastatic bone malignancy or primary hyperparathyroidism with brown tumor
2013
Multiple osteolytic lesions are usually associated with metastatic involvement of the bone. However metabolic bone diseases should also take their place in differential diagnosis. Here, we describe a primary hyperparathyroidism case with full-blown osteolytic lesions wich was diagnosed at first sight with having metastatic bone involvement. PET CT scan and laboratory results excluded a metastatic bone malignancy. Elevated serum calcium of 13.16 mg/dl, decreased serum phoshorus of 1.4 mg/dl and high intact-PTH level of 1054.7 pg/ml pointed out primary hyperparathyroidism. Sonographic examination revealed two adenomas of 2.9 × 3.3 mm and 3.3 × 2.7 mm in the left superior and right inferior parathyroid glands, respectively. Scintigraphy confirmed the presence of adenoma on the left.
Tertiary Hyperparathyroidism Presenting as Multifocal Brown Tumors: A Case Report
Journal Of Endocrinology And Metabolism Research, 2023
Brown Tumor (BT) of the bone is a rare manifestation of hyperparathyroidism (HPTH), an unusual reactive bone lesion attributed to disturbed bone remodeling, from long-standing increase in parathyroid hormone level (PTH). Historically, BTs were described with primary HPTH but due to early diagnosis of this entity, and improved survival in patients with end-stage renal disease (ESRD) especially those on renal replacement therapy (RRT), more cases of BT are now described in this population, and less in PHPTH. Thus, it is mostly the consequence of untreated secondary or tertiary HPTH whose major culprits are chronic kidney disease (CKD) and ESRD. The management of brown tumors related to chronic renal failure consists primarily of its prevention through the use of phosphate binders, vitamin D analogues, and calcimimetics with surgical parathyroidectomy reserved as the final resort in refractory cases. Herein, we present the case of a 24-year-old female patient with ESRD on intermittent hemodialysis (IHD) who developed recent onset facial tumefaction. Blood work revealed markedly elevated PTH at more than 5000 pg/ml, upper borderline hypercalcemia, and hyperphosphatemia. Further investigations with chest computed tomography (CT) and Technetium-99m (99mTc)- Sestamibi scan nuclear imaging showed multiple ribs lytic lesions as well as features of extensive BT and parathyroid adenomas. Thereafter, the patient was sent for parathyroidectomy after which the patient developed hungry bone syndrome.t developed hungry bone syndrome.
The spectrum of radiographic findings in primary hyperparathyroidism
2002
The aim of this study was to assess the spectrum of radiographic findings in primary hyperparathyroidism (PHPT). The study group consisted of 16 women and 7 men whose Ca levels were at least two or three times higher than normal. The average age was 55.3 in women and 49.4 in men. We detected carcinoma in 1, hyperplasia in 1, multiple adenomas in 4, single adenoma in 17 patients. The most common finding in the skeletal system was the decreased bone mineral density (BMD) and the complete loss of the lamina durae dentium. BMD was found lower in women than in men. This result attributed the increased number of postmenopausal patients in our study group. The second most common finding in our study group was subperiosteal bone resorption. Brown tumors (BTs) were located at maxilla in one, widespread in one, mandibula in two, long tubular bones in four patients. Renal stone disease was found in five, spastic colon in two, gastric ulcer in one, mitral valve calcification in one patients. We demonstrated no pathologic changes consistent with PHPT in remaining seven patients. D
Human Pathology: Case Reports, 2020
Introduction: Hyperparathyroidism is a condition caused by hyperactivity of parathyroid glands. It can cause a lytic bone lesion which similar to a Giant Cell Tumor (GCT) and is hard to differ from it. The common terms for these tumor-like bone lesions are osteitis fibrosa cystica or brown tumor and they represent the end stage of bone remodeling process in prolonged hyperparathyroidism. Case presentation: A 53-year-old female complained about pain around her right shoulder. Radiographic appearance showed that there are multiple lytic lesions on right proximal humerus and some other bones. Histopathology revealed that it was most consistent to GCT of the bone. Patient underwent tumor resection surgery and shoulder hemiarthroplasty. Post-operative evaluation showed that there was an increased level of serum calcium and ionized calcium, but decreased level of phosphate. Parathyroid hormone level was high. Patient was suggested to undergo further thorough examination for the underlying cause of hyperparathyroidism. But unfortunately, a couple months after surgery, patient passed away. Discussion: Based on the history, clinical, laboratory, and radiograph findings, we thought about multiple myeloma or metastatic bone disease at first. After histopathology report said that it was most consistent to GCT of the bone. We thought about multifocal GCT of the bone then. Since the incidence of multifocal GCT was considered very rare, the lesions were multiple, and the clinical condition was not suitable for GCT, we thought about possibility of metabolic condition. Further laboratory examination of serum calcium and phosphate turned out to be hypercalcemia and hypophosphatemia. Thus we thought about brown tumor of hyperparathyroidism. Parathyroid hormone level was checked later and turned out to be high. Conclusion: Brown tumor of hyperparathyroidism should be considered when we found a case of multifocal osteolytic bone lesions. Normally, we would thought about multiple myeloma or metastatic bone disease at first. But when the laboratory, radiographic and histopathological examination results did not correlate to those diagnosis, we should order serum calcium, phosphate and parathyroid hormone level evaluation for patients with multiple osteolytic lesions. Any misdiagnosis and further harmful mistreatment for patients should be avoided.
Osteitis fibrosa cystica—a forgotten radiological feature of primary hyperparathyroidism
Endocrine
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.
Multiple Brown Tumors in a Normocalcemic Patient with Primary Hyperparathyroidism - A Case Report
Bangladesh Journal of Nuclear Medicine, 2019
Brown tumor is a benign bone lesion that arises as a direct result of parathyroid hormone on bony tissue in some patients with hyperparathyroidism. Multiple brown tumors may simulate malignant disease and it is a real challenge for the clinicians in the differential diagnoses. Brown tumor as the only and initial symptom of normocalcemic primary hyperparathyroidism is a rare clinical entity. Here, we present a case with multiple brown tumors in a young normocalcemic woman as a sequele of primary hyperparathyroidism mimicking bone metastases. Bangladesh J. Nuclear Med. 22(1): 68-72, Jan 2019