Endocrine Abstracts

Brown tumor (BT) is a rare bony benign lesion caused by excess osteoclast activity and hemosiderin deposition because of uncontrolled primary or secondary hyperparathyroidism. 71-year-old man with no significant pathological history, twelve months before admission presented with growing mandibular brown tumor and bone pain in lower limbs. He was referred to Endocrinology unit. Physical examination found left facial paralysis, absence of horizontal branches and left jaw ascending. A total parathyroidectomy was performed without implantation of a parathyroid fragment into the forearm muscle. PTH was monitored intraoperatively, and the PTH level decreased. A histopathological examination of the mass confirmed the diagnosis of parathyroid adenoma with a tumor result of giant cells of 1.8 × 5 × 4 cm with necrotic and hemorrhagic areas and serum PTH level continued to decrease after surgery. Surgical resection of a brown tumor is generally not recommended and should only be considered if the patient wants quick resolution, if the bony lesion is compromising body functions or promoting facial deformation, or if the lesion fails to regress after 1–2 years. The 10-year duration of our case was too long, reflecting the inadequacy of preventing and managing brown tumors in underdeveloped countries like Peru where is from our patient. In developed countries, PHPT is mostly diagnosed by routine biochemical screening without clinical signs suggesting the disease, so the classical manifestations of PHPT are very uncommon. The case of an older adult patient with an unusual presentation of primary hyperparathyroidism by a mandibular-level brown tumor is present as an initial manifestation, which should be considered in differential diagnosis when evaluating a patient with a bone tumor at the maxillary level presenting with multifocal osteolytic bone lesions, although bone metastases and multiple myeloma still should be considered first.