Endocrine Abstracts

Aim and Introduction: Peripheral giant cell granulomas (PHDG) are uncommon exophytic lesions of the oral cavity that originate from the periosteum or periodontal membrane as a polypoid mass. Mandibular involvement is more common than maxillary involvement. Patients with primary hyperparathyroidism can infrequently exhibit PHDG in the early stages of the disease. We wanted to present our case who was examined for giant cell granuloma developing in the mandibula and was found to have parathyroid adenoma.

Case: A 47-year-old female patient with no known history of systemic disease applied to an external center due to swelling in the gingiva. The patient applied to us after a biopsy was taken due to a bone cyst detected at the level of the left second premolar tooth, and a giant cell granuloma that was detected. The patient’s creatinin was 0.5 mg/dl (0.51-0.95), PTH level was 163.9 ng/l (12-88), calcium was 10.1 mg/dl (8.8-10.6), phosphorus was 2.8 mg/dl (2.5-4.5), vitamin D was 10 ug/l (30-100), Alcaline Phosphatase was 182 U/l (30-120) and albumin was 41 g/l (35-52). On the ultrasonography of the thyroid, a 3x4x7 mm hypoechoic nodular formation compatible with a parathyroid adenoma was observed in the inferior right thyroid lobe. SESTAMIBI parathyroid scintigraphy revealed a nodular lesion compatible with adenoma. Excision of a parathyroid adenoma was planned for the patient. In the inferior right lobe, a 1x0.5 cm mass consistent with an adenoma was removed. PTH decreased to 53 ng/l 15 minutes after specimen extraction in the patient whose pre-operative PTH was 161 ng/l. The macroscopic appearance of the specimen was reported as a 0.5 g weight, uniformly encapsulated yellow-brown nodular excision material. A peripheral giant cell granuloma developing in the jaw in a patient with normocalcemic primary hyperparathyroidism was evaluated as an early complication of the disease.

Conclusion: Giant cell granulomas that develop in peripheral bones such as the jaw may also occur in the early stages of the disease, and it should not be forgotten that they may be the first sign of the disease. Patients with giant cell granuloma in the oral cavity should be examined for hyperparathyroidism even if the calcium level is normal. Although there is no definitive treatment protocol, parathyroid adenoma excision can be performed.