Endocrine Abstracts

Introduction: Hyperparathyroidism is a frequent endocrinopathy, often diagnosed in the stage of asymptomatic hypercalcemia. The revelation by a bone or renal complication has become increasingly rare dominated by osteoporosis and brown tumors giving a blown aspect of the cortices exposing to pathological fractures. We report 2 cases of primary hyperparathyroidism revealed by a brown tumor and pathological fracture.

Observation 1: This is a 52 year old female patient, followed up for bilateral renal lithiasis for 20 years, admitted for etiological assessment of bone lesions of the pelvic girdle discovered incidentally on a uroscanner, without polyarthralgias, without polyuropolydipsic syndrome nor constipation nor nausea nor vomiting nor fever. The diagnosis of a primary hyperparathyroidism was retained in front of a corrected hypercalcemia to 119 mg/l a hyperparathormonemia to 1200 ng/l and a normal phosphatemia to 25.34 ng/ml, a calciuria of 24 h raised to 268 mg/24 h with localization of a parathyroid adenoma to the ultrasound. Parathyroid scintigraphy with Sestamibi not done due to the patient’s lack of financial means.

Observation 2: The patient was 66 years old, without any pathological history, admitted for exploration of a primary hyperparathyroidism revealed by a fracture of the femoral diaphysis on a pathological bone whose anatomopathological examination was in favor of a brown tumor. The biological work-up revealed a corrected hypercalcemia at 140 mg/l, a hyperparathomemia at 1936 ng/ml, a hypophosphatemia at 23.17 mg/l, a 24-hour high calciuria at 246 mg/24 h, and on ultrasound and cervico-thoracic CT scan a parathyroid adenoma of 2.7 cm confirmed by the histological study. The evolution was marked by the installation of the hungry bone syndrome with a good evolution under calcium supplementation.

Conclusion: Brown tumors represent a rare and not exceptional bone complication to be evoked in front of each lytic giant cell lesion and requiring the search for primary hyperparathyroidism given the insidious character of this endocrinopathy while eliminating an underlying malignant process.