Endocrine Abstracts

Objectif

Brown tumour is a rare focal bone lesion encountered in patients with uncontrolled hyperparathyroidism (HPT). This disease affects only 1.5% of patients with secondary HPT. This bone lesion can affect any part of the skeleton. The treatment is mainly medical based on reducing the rates of parathyroid hormone (PTH). Surgery is reserved for severe form of brown tumour or in case of uncontrolled level of PTH. The aim of our work is to illustrate the clinical and therapeutic features of these rare tumour.

Patients and methods

This is a retrospective study of 5 chronic hemodialysis patients who developed a brown tumour due to secondary hyperparathyroidism. This study was carried out over a period of 10 years from 2008 to 2018.

Results

The average age of our patients was 38 years old with a sex ratio of 1.5. The average time to diagnosis brown tumours was 5 years. These tumours were located in the mandible in two cases, sternum bone in 1 case and femora in 2cases. The Mean serum calcium level was 1.90 mmol/l, the mean phosphoremia level was 2.20 mmol/l and the mean PTH level was 1500 pg/l. All patients had subtotal parathyroidectomy. Histologic examination of the gland showed parathyroid hyperplasia in all cases. No patient underwent intervention on the tumour. The outcome was favorable in all patients with clinical and radiological stabilization of bone lesions in 2 cases and spontaneous regression after parathyroidectomy in 3 patients without any recurrence.

Conclusion

Patients with chronic renal insufficiency may develop brown tumours in advanced stages of the disease as a result of uncontrolled hyperparathyroidism. Treatment is based on reducing the levels of PTH, either through medical management, or parathyroidectomy. The patient’s prognosis is favourable, but the possibility of kidney transplantation to prevent relapse and the development of further brown tumours will have to be considered.