scholarly journals An Unusual Presentation of Primary Hyperparathyroidism: Pathological Fracture

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Ben Abdelghani Khaoula ◽  
Ben Abdelghani Kaouther ◽  
Chelly Ines ◽  
Turki Sami ◽  
Leith Zakraoui ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Female Patient ◽  
Calcium Level ◽  
Pathological Fracture ◽  
Unusual Presentation ◽  
Uneventful Recovery ◽  
Brown Tumor ◽  
Pathological Findings ◽  
Pth Level

Primary hyperparathyroidism revealed by a pathological fracture is very uncommon. We present a case of a 54-year-old female patient who was admitted with fracture of her right femur. She underwent closed intramedullary reconstruction nailing with bipolar locking. The pathological findings confirmed the diagnosis of primary hyperparathyroidism with brown tumor. Further tests showed increased both calcium level and PTH level. A parathyroidectomy was performed. She made an uneventful recovery and was discharged to home.

scholarly journals Brown Tumor of the Ulna and Radius: An Unusual Presentation of Primary Hyperparathyroidism

2008 ◽  
Vol 23 (5) ◽  
pp. 347
Author(s):  
Hyun Park ◽  
Gun Hi Kang ◽  
Seung Gu Kim ◽  
Jun Jae Kim ◽  
Na Na Baek ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Unusual Presentation ◽  
Brown Tumor

Brown Tumors of the Mandible Revealing Hyperparathyroidism: About Two Cases

2021 ◽  
Vol 11 (12) ◽  
pp. 128-133
Author(s):  
Hela Zouaghi ◽  
Dorsaf Touil ◽  
Raouaa Belkacem Chebil
Keyword(s):  
Parathyroid Hormone ◽  
Female Patient ◽  
Case Reports ◽  
Panoramic Radiograph ◽  
Osteitis Fibrosa ◽  
Brown Tumor ◽  
Osteolytic Lesions ◽  
Osteitis Fibrosa Cystica ◽  
High Level ◽  
Pth Level

The diagnosis of osteolytic lesions of the jaws can be challenging. Case Reports: Two cases of brown tumor of hyperparathyroidism were reported. A 76- year-old female patient presented with indolent swelling of her right lower jaw measuring approximately 5 cm /6 cm. The panoramic radiograph showed a well-defined osteolytic radiolucency involving the entire mandibular symphysis. Blood investigations revealed High level of parathyroid Hormone (PTH): 102pg/ml. The diagnosis of a brown tumor of hyperparathyroidism was suspected. A parathyroid technetium scintiscan revealed abnormally high uptake at the lower pole of the thyroid lobe interpreted as hyperplasia of right inferior parathyroid gland with possible brown tumor of the mandible. Second case: A 36- year-old female patient presented for the replacement of her missing teeth. Her medical history revealed chronic renal failure and a recent surgical excision of an Osteitis fibrosa cystica of her fifth left proximal phalange. Panoramic radiograph showed multiple well defined osteolytic lesions of the mandible. The diagnosis of a brown tumor of the mandible secondary to hyperparathyroidism was suspected. Laboratory investigations showed increased PTH level, serum hypocalcemia and hyperphosphatemia and vitamin D deficiency. The patient was referred to the department of endocrinology for further investigation and the correction of PTH level. At Six months follow up all the lesions disappeared on radiological control. Discussion: Brown tumor of hyperparathyroidism is a metabolic disorder causing bone resorption that can affect the jaw bones. Clinical symptoms depend on the size and the location of the lesion. Radiographically, it appears as radiolucent unique or multiple well-defined intra-osseous radiolucency. Biological examination is the key to the diagnosis and it is marked by high level of parathyroid hormone (PTH). Key words: Jaw, Tumors, Osteitis Fibrosa Cystica, Hyperparathyroidism, Diagnosis.

scholarly journals SAT-364 Brown Tumor of the Mandible in Severe Uncontrolled Primary Hyperparathyroidism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Suruchi K Gupta ◽  
Runhua Hou ◽  
Harold Rosen
Keyword(s):  
Primary Hyperparathyroidism ◽  
Ct Scan ◽  
The United States ◽  
Osteitis Fibrosa ◽  
Brown Tumor ◽  
Osteitis Fibrosa Cystica ◽  
Hypercalcemia Of Malignancy ◽  
Brown Tumors ◽  
The Right ◽  
Pth Level

Abstract Background: Brown tumors are a part of the complex “osteitis fibrosa cystica” which is a diffuse resorptive process of the bone resulting from uncontrolled hyperparathyroidism. Although these brown tumors were fairly common in the past1, the incidence of brown tumors is now extremely rare in the United States due to early diagnosis and treatment of hyperparathyroidism. Here we describe an unusual presentation for osteitis fibrosa cystica. Clinical Case: A 38 year old woman was admitted to the hospital with rapidly growing facial swelling in June 2019. The swelling initially appeared in January 2019 and had rapidly increased in size since April 2019. The mass was malodorous, painful and interfered with oral intake. The patient smoked 1 pack per day for 13 years. A CT scan of the head and neck with contrast showed a 3.6 x 4.5 x 3.3 cm mass destroying the right mandibular body, involving the right platysma muscle and displacing the central and lateral incisor teeth and was concerning for malignancy. The initial impression was that this was likely a squamous cell carcinoma with local and perhaps distant metastases, complicated by humoral hypercalcemia of malignancy and she was admitted for management. Upon admission, her calcium level was 14 mg/dL, albumin 4.1 g/dL, phosphorus 1.4 mg/dL PTH level was 890 pg/mL and vitamin D level was 22 ng/mL. Since the high PTH did not fit with hypercalcemia of malignancy, further evaluation was undertaken. A thyroid ultrasound showed a 4.6 x 1.8 x 1.5 cm isoechoic, heterogeneous lesion in the left lower pole, and Tc-99 sestamibi scan suggested parathyroid origin. The biopsy of the mouth lesion showed fibro histiocytic proliferation with multiple giant cells, negative for malignancy and consistent with a brown tumor. CT scan of the chest, abdomen and pelvis did not reveal any other masses or lytic lesions. . A skeletal survey showed another 2 cm lytic lesion in the proximal left humeral metaphysis which was not biopsied. On parathyroidectomy, the patient was found to have an enlarged left inferior parathyroid gland measuring 3.3 x 3.0 x 0.8 cm weighing 7.093 grams. Intraoperatively PTH level decreased from 890 pg/mL to 69 pg/mL. Her calcium levels returned to normal post-operatively and she was discharged home. Pathologic examination report revealed the mass to be a parathyroid adenoma. The patient reports a reduction in the size of her mandible mass since the surgery. Conclusion: Although uncommon, brown tumors can be seen in uncontrolled primary hyperparathyroidism. The mandible is a common site, though, as in this case, it is less common for it to be the only site affected Reference: 1. Rosenberg, E. H. (1962). Hyperparathyroidism. A review of 220 proved cases with special emphasis on findings in the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 15(2), 84–94.

scholarly journals An Unusual Presentation of Primary Hyperparathyroidism: Ectopic Parathyroid Gland and Multiglandular Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A181-A182
Author(s):  
Sonia Helen Perez-Cavero ◽  
Marlon Augusto Yovera Aldana ◽  
Carlos Zubiate
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Thyroid Tissue ◽  
Unusual Presentation ◽  
Multiglandular Disease ◽  
Intact Pth ◽  
Blood Calcium ◽  
Parathyroid Disease ◽  
Very High ◽  
Pth Level

Abstract Primary hyperparathyroidism (PHPT) can be associated as a single parathyroid adenoma in approximately 85% of patients, the remaining 15% of them correspond to individuals with hyperplasia. The multiglandular parathyroid disease varies in range 7–33% and contribute a persistent PHPT. We report a case of primary hyperparathyroidism with an unusual presentation of ectopic mediastinal parathyroid. The case was of a 54-year-old female, who started her illness 3 years ago, with frequent headache, regular fatigue and muscle pain, denied losing weight. She was admitted to emergency room for a urinary infection. During the hospitalization showed bilateral nephrocalcinosis, hypercalcemic crisis. She has a background of total thyroidectomy and subtotal parathyroidectomy because a thyroid adenomatous hyperplasia and parathyroid hyperplasia with removal of a total of three parathyroid glands. She had very high PTH level. Laboratory: serum calcium: 16.8mg/dl; ionic calcium: 2.37 mmol/L; P: 1.9 (2.7–4.5g/dL); Hb: 9 g/dL; Platelets: 558 000 per microliter; Leukocytes 9 600 cells/mcL; Albumin: 4g/dl; TSH: 0.06 mU/L; fT4: 1.29 (L-T4 doses were 100 ug). Four months after parathyroid surgery, the intact PTH level dropped from 1602 ng/l to 550 (15–65 ng/L). Computed tomography and Tc-sestamibi scintigraphy - SPECT revealed a residual cervicothoracic mass in retroesophageal region (D1-D2) (Fig1 -2). The patient underwent a new surgery and the intact PTH dropped 39ng/L. Histopathology revealed characteristic features of a parathyroid adenomatous (10 gram weight) (Fig.3); additionally a retroesternal ectopic thyroid tissue. There was not reappearance of high blood calcium and parathormone levels more than 6 months after second surgery for PHPT. An unusual case of PHPT caused by a multiglandular disease parathyroid varies (four glands and a ectopic gland), reliable histopathologic adenomatous and hyperplastic parathyroid disease, and persistent primary hyperparathyroidism with very high serum intact PTH level. Reference: (1) Masi L. Primary Hyperparathyroidism. Brandi ML (ed): Parathyroid Disorders. Focusing on Unmet Needs. Front Horm Res. Basel, Karger, 2019, vol 51, pp 1–12. (2) Pecheva M, Mahendran K, Kadlec J, Lofthouse M1, Van Tornout F. Mediastinal giant parathyroid adenoma-a minimally invasive mediastinal surgical approach for an emergency presentation. Ann Cardiothorac Surg. 2016 Jan;5(1):70–3. (3) Cakmak H 1, Tokat AO, Karasu S, Özkan M. Adenoma paratiroideo mediastínico gigante. Tuberk Toraks. 2011; 59 (3): 263–5. (4)Thier M, Daudi S, Bergenfelz A, Almquist M. Predictors of multiglandular disease in primary hyperparathyroidism. Langenbecks Arch Surg. 2018;403(1):103–109.

scholarly journals Sestamibi Positive Vs Negative Scan In Primary Hyperparathyroidism; A Clinical Dilemma

2016 ◽  
Vol 17 (2) ◽  
pp. 142-145 ◽  
Author(s):  
Hosne Ara Rahman ◽  
Jasmine Ara Haque ◽  
Samira Sharmin
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Calcium Level ◽  
False Negative ◽  
Abnormal Parathyroid Gland ◽  
Clinical Dilemma ◽  
Serum Pth ◽  
Primary Hyperthyroidism ◽  
Pth Level ◽  
Negative Scan

Objectives: In primary hyperthyroidism Tc-99m Sestamibi (MIBI) scanning is commonly used for localization of abnormal parathyroid gland and the reported sensitivity is very high. However, false negative scan remain a problem. We examined whether serum calcium and parathormone (PTH) level have any impact in the sensitivity of MIBI scan.Study design: A retrospective review of 55 patients with primary hyperparathyroidism who underwent MIBI scan from January 2012 to December 2014 were included in this study. All patients underwent parathyroid surgery followed by histopathological confirmation.Results: In total, 55 patients were studied. Mean age was 41.3 ± 19.8 years (range 21-63 years). MIBI scan was true positive in 37 cases and false negative in 18 cases. The sensitivity of MIBI scan was 67.2 %. Mean serum calcium level was 12.3 mg/ dL. More than 62.2 % of patients with calcium level greater than 12.3 mg/dL had a positive scan as compared with 37.8% of those with lesser value (P<0.05). Similarly a serum PTH level greater than 316 ± 139 pg/mL correlated with positive scans in 78.4 % as opposed to 21.6 % in those with lower levels (P< 0 .01).Conclusion: Lower calcium and PTH level significantly correlate with reduced sensitivity of MIBI scan. Although we did not find the best cut-off level of serum calcium and PTH level that can predict a positive scan.Bangladesh J. Nuclear Med. 17(2): 142-145, July 2014

Sphenoid sinus brown tumor, hypercalcemia, and blindness: An unusual presentation of primary hyperparathyroidism

1986 ◽  
Vol 8 (5) ◽  
pp. 379-386 ◽  
Author(s):  
Vanessa G. Schweitzer ◽  
Norman W. Thompson ◽  
Kenneth D. McClatchey
Keyword(s):  
Primary Hyperparathyroidism ◽  
Sphenoid Sinus ◽  
Unusual Presentation ◽  
Brown Tumor

PARATHYROID HORMONE SECRETION IN DISORDERS OF CALCIUM METABOLISM STUDIED BY MEANS OF EDTA

1974 ◽  
Vol 75 (2) ◽  
pp. 286-296 ◽  
Author(s):  
J. H. Lockefeer ◽  
W. H. L. Hackeng ◽  
J. C. Birkenhäger
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Calcium Metabolism ◽  
Hormone Secretion ◽  
Parathyroid Tissue ◽  
Small Mass ◽  
Idiopathic Hypercalciuria ◽  
List Type ◽  
Immunoreactive Parathyroid Hormone ◽  
Pth Level

ABSTRACT In 22 of 28 cases of primary hyperparathyroidism (PHP) the rise in the serum immunoreactive parathyroid hormone (IRPTH or PTH) level observed in response to lowering of the serum calcium by EDTA, exceeded that obtained in 8 control subjects. In 5 of these 22 patients who were studied again after parathyroidectomy the supranormal response was abolished. Fifteen of these 22 hyper-responsive PHP patients had basal IRPTH levels not exceeding the highest level in the controls and that of other groups of patients investigated (idiopathic hypercalciuria, non-parathyroid hypercalcaemia, operated PHP). Fourteen of the 22 hyper-reactive patients with PHP did not show hypocalcaemia during the infusion of EDTA. The extent of the release of PTH elicited by EDTA in cases of PHP does not as yet allow a prediction of the amount of pathological parathyroid tissue present, although all the PHP patients showing a normal release of PTH had a relatively small mass of parathyroid tissue (up to about 1 g) subsequently removed. In 9 cases of nephrolithiasis (8 of whom had idiopathic hypercalciuria) and in 7 cases of non-parathyroid hypercalcaemia, a normal PTH release was found.

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