Mandibular Osteitis Fibrosa Cystica as First Sign of Vitamin D Deficiency

Abstract

Introduction Brown tumors of hyperparathyroidism are locally destructive bone lesions. They are the late clinical consequence of the disease. They can occur in primary, secondary, and rarely tertiary forms. They affect usually long bones and less frequently those of the maxilla. Case Report Our 45-year-old female patient presented with a mandibular tumor next to the first right lower molar. At first, we have chosen tooth extraction and tumor excision. When the histological report showed the giant cell tumor we suspected a metabolic bone disorder. Biochemical tests screened hyperparathyroidism and severe vitamin D deficiency, and parathyroid scintiscan revealed parathyroid adenoma. Discussion The association of hyperparathyroidism and vitamin D deficiency leads to diagnostic uncertainty. First, secondary hyperparathyroidism can be due vitamin D deficiency. Second, data available show that vitamin D deficiency is more prevalent in patients with primary hyperparathyroidism than in general population. Hyperparathyroidism management is based on correct and precise diagnosis. Furthermore, the resolution of brown tumors depends on the cure of hyperparathyroidism. In fact, bone lesions should regress after biological tests' normalization. Conclusion Clinicians should be aware of such rare and complicated presentation. They must consider the diagnosis of the brown tumor to avoid extensive surgical excision and teeth extractions.

Brown Tumors of the Jaws: A Retrospective Study

“…Schematically, it is reported that chronic vitamin D deficiency would lead to an autonomous stimulation of the parathyroid and would cause the serum calcium level to drop into normal values, creating the doubt toward the HPTH diagnosis which was reported in this study. 21,22 • • Secondary HPTH is usually marked by hypocalcemia as in 2 of our cases. Although normal levels of calcium that tend toward the inferior limit can also be reported.…”

“…Schematically, it is reported that chronic vitamin D deficiency would lead to an autonomous stimulation of the parathyroid and would cause the serum calcium level to drop into normal values, creating the doubt toward the HPTH diagnosis which was reported in this study. 21,22…”

Follow-Up of Brown Tumor in Mandible with Vitamin-D Use: A Rare Case Report

“…Cerrahi olmayan bu medikal tedavi süresince, hastamızda olduğu gibi PTH seviyeleri kontrol edildiğinde düşme olduysa genellikle lezyon geriler. 15…”

Epistaxis as an initial symptom of brown tumor in hard palate: a rare case report and review

“…Secondary hyperparathyroidism (SHPT), which is induced by defective phosphate excretion and failure of vitamin D activation, also plays a role in brown tumor formation. Elevated phosphate levels, as well as decreased calcium and serum vitamin D levels, lead to the persistent stimulation of the parathyroid glands, which increases PTH release [12][13][14]. Hyperparathyroidism may present as anorexia, vomiting, constipation, fatigue, weight loss, muscle weakness, psychiatric symptoms, anemia, polydipsia, urologic changes, and recurrent symptoms of kidney stones during the early stage [15,16].…”