ECE2018 Poster Presentations: Calcium and Bone Clinical case reports - Thyroid/Others (12 abstracts)
Regression of multipl brown tumors after surgical removal of mediastinal ectopic parathyroid adenoma
Sezin Dogan Cakir 1 , Rumeysa Selvinaz Erol 1 , Emre Sedar Saygılı 1 , Seda Erem Basmaz 1 , Adnan Batman 1 , Feyza Yener Ozturk 1 , Esra Cil Sen 1 , Muhammed Masum Canat 1 , Duygu Yildiz 1 , Ezel Ersen 2 & Yuksel Altuntas 1
1University Of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Department of Endocrinology and Metabolism, Istanbul, Turkey; 2Istanbul University, Cerrahpasa Faculty Of Medicine, Department of Thoracic Surgery, Istanbul, Turkey.
Introduction: Parathyroid adenoma is the most common cause of primer hyperparathyroidism (PHPT). Mediastinal ectopic parathyroid adenomas constitute about 1–3% of the cases. Brown tumors ocur in less than 2% of the patients with PHPT. Moreover, those skeletal manifestations are even rarely demonstrated with maxillofacial bones involvement.
Case presentaton: Here we report a 36-years-old woman presented with approximately 30×26 mm mass growth in her mandible. She had been suspected for malignancy because of detected hypercalcemia and multipl lytic bone lesions. However, the biopsy of femur has been reported with no evidence of malignancy. Our laboratory findings revealed PTH dependent hypercalcemia (Calcium=12.76 mg/dl (8.6–10.2), PTH=1373 pg/ml (15–65), P=1.8 (2.6–4.5), Mg=1.93 mg/dl (1.6–2.6), creatinin=0.73 mg/dl (0–0.95), ALP=401 U/L (35–105), 24 h urinaryCa=450 mg/24 h (100–300)). In bone scintigraphy, multipl foci of technetium-99 m uptake in calvarium, mandible, sternoclavicular joint, bilateral humerus, femur, sacroiliac joint, right iliac crest, costa and vertebra were detected. Maxillofacial CT scan identified multiple expansile lesions from 10×9 to 30×26 mm in frontal bone, hard palate, maxillary sinüs and mandible. Cervical sonography was unremarkable. Tc-99-m-MIBI scintigraphy revealed a 20 mm parathyroid lesion in the anterior mediastinum at subcarinal level. After intravenous hydration, loop diuretic, bisphosphonate and cinacalcet treatment, a thoracoscopic surgery was performed. The histopathology of the tissue was consisted with a parathyroid adenoma. Hungry bone syndrome occured following surgery and was treated with oral calcium and calcitriol for about 10 months. Over a year later, she has normal serum calcium and PTH levels. Control CT scan revealed a remarkable regression in Brown tumors and some of them did not even detected.
Conclusion: Brown tumors may mimic cancer metastasis therefore can be misdiagnosed. Physicians should always consider PHPT in the differential diagnosis. The most important way to distinguish these skeletal manifestations of PHPT from malignancy is by biochemical analysis with serum calcium and PTH levels. For localisation of PHPT, ectopic locations should also be evaluated if neck imagination reveals no lesion.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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