Endocrine Abstracts

Primary Hyperparathyroidism is a common endocrine disorder characterized with high parathyroid hormone (PTH) and calcium (Ca) levels. Although most of the patients are asymptomatic, some patients may be presented with renal, gastrointestinal, musculoskeletal, neurologic or cardiovascular signs associated with hypercalcemia or elevated parathyroid hormone related findings such as bone disease, nephrolithiasis, hypophosphatemia increased production of calcitriol, hypomagnesemia, hyperuricemia and anemia. Brown tumor is one of the manifestations of Primary Hyperparathyroidism and is more commonly found in trabecular bone pattern of the mandible, bones of the upper and lower extremities and ribs.

Case: A 54 year-old female with a history of recurrent nephrolithiasis was referred with fragile bones fractures. Biochemical assay revealed an increased value of serum PTH 1570 pg/ml and calcium 13.5 mg/dl. The serum phosphorus level was 3.4 mg/dl, ALP:14 IU/l, 25OH vitamin D:<8 μg/l.

Direct radiographies revealed multipl lesions of the upper and lower extremities, iliac bones, femoral heads, sacrum, sternum, ribs and vertebrae. A complete blood count (CBC) of the patient revealed a low hemoglobin and hematocrit levels (Hg:6.93 g/dl, Htc:20.00%). There was no evidence of neutropenia or leucopenia. After consulting to Hematology department, it was reported that anemia was associated with diffuse bone lesions and it was not possible to make bone marrow biopsy due to diffuse bone lesions. Follow up of anemia for recovery after parathyroidectomy was also suggested. Ultrasound of neck revealed mass of 3 cm associated with parathyroid adenoma. After erythrocytes transfusions, the patient was planned for surgery.

Multipl bone lesions are common in Primary Hyperparathyroidism and Brown tumor may also be a part of this clinical condition. These lesions are usually localized and have a tendency for recovery of the primary disease. It should be in mind that diffuse bone marrow lesions may be seen resulting progenitor cells failure in bone marrow and cytopenia.