Primary hyperparathyroidism presented with peripheral brown tumor in the oral cavity: a case report

Abstract

Introduction: Parathyroid hormone (PTH) is the chief regulator of calcium homeostasis in the human body. Primary hyperparathyroidism (PHPT) occurs in a setting of excessive PTH secretion with an autonomous parathyroid gland which resulting in hypercalcemia [1]. Most patients with PHPT have a single adenoma (about 80% of cases), but multigland disease can occur in 10%-15% of cases and double adenomas in 4%-5% [2]. Parathyroid carcinoma is a rare cause (usually less than 1% of patients) of hyperparathyroidism [3,4]. There is a great variation in the manifestations of PHPT. The clinical presentation of PHPT is changing from a severe disease with nephrolithiasis and metabolic bone disease to mild asymptomatic disease [5,6]. The most common clinical presentation of PHPT is asymptomatic hypercalcemia with an elevated or high-or normal intact PTH level. Patients with hypercalcemia may present with vague constitutional symptoms, anorexia, lethargy, or polydipsia and polyuria [7][8][9]. Less specific features of PHPT are fatigue, proximal muscle weakness, mild cognitive disturbances, hypertension, left ventricular hypertrophy, valvular calcification, and cardiovascular mortality [2,10]. Classic skeletal lesions, which are bone resorption, bone cysts, brown tumors and generalized osteopenia, occur in less than 5% of cases [11]. PHPT affects compact bone more than trabecular bone with particular sensitivity in the cortices of long bones leading to subperiostal bone resorption (seen as periosteal elevation on plain radiography) [12]. PHPT is prone to cause loss of the lamina dura [13].

An Endocrine Jaw Lesion: Dentist Perspective in Diagnosis

“…Classic skeletal lesions like bone resorption, bone cysts, brown tumors, and generalized osteopenia occur in less than 5% of all HPT cases [4]. The incidence of these skeletal lesions in HPT patients has fallen from 80% to 15% currently, which is attributed to better biochemical monitoring of calcium levels [5].…”

“…One of the skeletal lesions observed in HPT is brown tumor [4], also termed as Von Recklinghausen's disease of bone or osteitis cystica fibrosa. Due to the presence of excessive hemorrhage, vascularization, and hemosiderin deposits grossly, a characteristic brown color is attained and thus the name “BROWN TUMOR” is derived [5].…”