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 OJIM  Vol.3 No.2 , June 2013
Diagnostic dilemma: metastatic bone malignancy or primary hyperparathyroidism with brown tumor
Abstract: 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 mmand 3.3 ×2.7 mmin the left superior and right inferior parathyroid glands, respectively. Scintigraphy confirmed the presence of adenoma on the left.
Cite this paper: Hatipoglu, E. , Eskazan, A. , Celik, O. , Kantarci, F. and Kadioglu, P. (2013) Diagnostic dilemma: metastatic bone malignancy or primary hyperparathyroidism with brown tumor. Open Journal of Internal Medicine, 3, 60-62. doi: 10.4236/ojim.2013.32015.
References

[1]   Bruder, J.M. and Mundy, G.R. (2001) Mineral metabolism. In: Felig, P. and Frohman, L.A., Eds., Endocrinology ? Metabolism, 4th Edition, McGraw-Hill, Inc., New York, 1079-1177.

[2]   Khalil, P.N., Heining, S.M., Huss, R., Ihrler, S., Siebeck, M., Hallfeldt, K., Euler, E. and Mutschler, W. (2007) Natural history and surgical treatment of brown tumor lesions at various sites in refractory primary hyperparathyroidism. European Journal of Medical Research, 12, 222-230.

[3]   Alcalay, M., Azais, I., Brigeon, B., Babin, P., Vandermarcq, P., Debiais, F. and Bontoux, D. (1995) Strategy for identifying primary malignancies with inaugural bone metastases. Revue de Rhumatisme, 62, 632-642.

[4]   Brage, M.E. and Simon, M.A. (1992) Evaluation, prognosis, and medical treatment considerations of metastatic bone tumors. Orthopedics, 15, 589-596.

[5]   Rougraff, B.T., Kneisl, J.S. and Simon, M.A. (1993) Skeletal metastases of unknown origin. The Journal of Bone & Joint Surgery, 75, 1276-1281.

[6]   Taillefer, R., Boucher, Y., Potvin, C. and Lambert, R. (1992) Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetinum-99 m-sestamibi (double-phasestudy). Journal of Nuclear Medicine, 33, 1801-1807.

[7]   Weiss, R.R., Schoeneman, M.J., Primack, W., Rozycki, D., Bennett, B. and Greifer, I. (1980) Maxillary brown tumor of secondary hyperparathyroidism in a hemodialysis patient. Journal of the American Medical Association, 243, 1929-1930.

[8]   Dusunsel, R., Guney, E., de Gunduz, Z., Poyrazoglu, M.H., Yigitbasi, O.G. and Kontas, O. (2000) Maxillary brown tumor caused by secondary hyperparathyroidism in a boy. Pediatric Nephrology, 14, 529-530

[9]   Schweitzer, V.G., Thompson, N.W. and McClatchey, K.D. (1986) Sphenoid sinus brown tumor, hypercalcemia, and blindness: An unusual presentation of primary hyperparathyroidism. Head and Neck Surgery, 8, 379-386. doi:10.1002/hed.2890080509

[10]   Vander Walde, L.H., Liu, I.L., O’Connell, T.X. and Haigh, P.I. (2006). The effect of parathyroidectomy on bone fracture risk in patients with primary hyperparathyroidism. Archives of Surgery, 141, 885-891. doi:10.1001/archsurg.141.9.885

[11]   Simon, M.A. and Springfield, D. (1998) Surgery for bone and soft tissue tumors. Lippincott-Raven, Philadelphia.

 
 
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