Brown tumor of hyperparathyroidism with multiple lesions

Abstract

Brown tumors are rare focal giant-cell lesions that arise as a direct result of the effect of parathyroid hormone (PTH) on bone tissue in some patients with hyperparathyroidism. Browns tumor is a syndrome associated with an increase in PTH levels by parathyroid glands resulting in hypercalcemia. In the present case report, a 44-year-old female patient presented with a rare case of brown tumor with multiple lesions in the head-and-neck region. The recent advance in various diagnostic and biochemical tests helps in early diagnosis of hyperparathyroidism cases. The dentist should be aware of oral manifestations associated with this type of systemic disease.

Brown Tumor in Parathyroid Adenoma Mimicking Malignant Bone Tumor: A Case Report

“…However, when the parathyroid glands malfunction, there is an abnormal increase in PTH secretion, resulting in heightened calcium reabsorption and bone resorption. Consequently, this leads to elevated levels of PTH and calcium in the bloodstream (Majumdar et al, 2022). In our case, there is a notable elevation in PTH levels (415pg/mL) accompanied by slight increase in calcium level.…”

Update on brown tumor of hyperparathyroidism

“…Clinically, HP (particularly PHP) 16 presents as "stones, bones, and groans," where "stones" refer to recurrent kidney stones, "bones" refer to bone pain, loss of bone mass, and fractures, and "groans" describe psychic groans and gastrointestinal symptoms such as vomiting, nausea, peptic ulcers, and pancreatitis 3 - 5 , 12 . Other findings include hypercalcemia 5 , 12 , anorexia 5 , 10 , bloating 10 , constipation 10 , weight loss 5 , muscle weakness 12 , pruritus 12 , soft tissue or vascular calcifications 12 , polyuria 10 , nocturia 10 , polydipsia 10 , and nephrolithiasis 10 , 12 .…”

“…In the bones, it acts by stimulating the action of osteoclasts which, by enzymatic action, reabsorb the matrix and solubilize calcium 1 . Therefore, PTH plays a key role in serum calcium homeostasis 1 - 3 .…”

“…Excessive production of PTH 4 - 10 may occur due to primary hyperparathyroidism (PHP), phosphate retention, skeletal resistance to PTH, impaired PTH degradation, and altered calcium-PTH feedback regulation in secondary hyperparathyroidism (SHP) or persistent tertiary hyperparathyroidism (THP) 2 , 3 , 11 , 12 . Increased PTH production results in hypercalcemia 3 , due to increased calcium absorption in the intestine, increased renal tubular reabsorption, and increased osteoclastic activity 4 , 5 , 11 which leads to bone demineralization, resulting in microfractures hemorrhage, hemosiderin deposition 13 , and excessive vascular proliferation that give such lesions the characteristic brown staining, justifying the nomenclature brown tumor of hyperparathyroidism (BTH) 4 , 5 .…”

Brown tumor in hyperparathyroidism; a new look at an old problem

“…Only solid, mixed solid, and cystic, or cystic lesions may be detected. The diagnosis mainly relies on biopsy and excessively increased parathyroid hormone (5).…”