Primary Hyperparathyroidism Presenting as a Palatal and Mandibular Brown Tumor

Abstract

Primary hyperparathyroidism is a fairly frequent pathologic diagnosis characterized by hypersecretion of parathyroid hormone, which results from adenomas in 80% to 85% of all cases. At clinical onset, the most common symptoms are hypercalcemia-related and some of them are pain due to kidney stones, polyuria, gastrointestinal, and neurologic disorders, whereas rarer symptoms are due to brown tumors and expansive lesions often found in fibrocystic osteitis. Brown tumors represent the terminal stage of the remodeling processes caused by an increased osteoclastic activity and fibroblastic proliferation during primary or secondary, albeit more seldom, hyperparathyroidism. The manifestation of primary hyperparathyroidism as skeletal disease has nearly disappeared in the last 2 decades. Cases are now most often diagnosed by the coincidental finding of asymptomatic hypercalcemia. Advanced screening techniques have made clinical evidence of bone disease rare. This article contains a case of brown tumor on the maxilla, palate, and mandible in addition to nephrectomy and proximal femur fracture, which are probably associated with primary hyperparathyroidism although less common nowadays. The diagnosis was suggested by the clinical history and confirmed by biochemical, radiologic, and histopathologic evidence. Excision of a parathyroid adenoma normalization of the metabolic status was then realized.

Cherubism

“…Other fibroosseous lesions containing multinucleated giant osteoclastlike cells such as brown tumor of hyperparathyroidism and aneurysmal bone cysts may be included in the differential diagnosis. Brown tumor associated with hyperparathyroidism can be distinguished from cherubism by laboratory studies exhibiting elevated levels of serum calcium and parathyroid hormone [6]. Aneurysmal bone cyst may also exhibit giant cells microscopically, but its main feature is a cavity that consists of hemorrhagic and blood-filled cavernous spaces separated by fibrous septa.…”

Dental management of patients with endocrine disorders

“…It occurs when the parathyroids activity becomes autonomous and excessive, leading to hypercalcemia (8). The diagnosis of HPT is suspected by an increase in serum calcium and it is confirmed by the increase in PTH (12). One of the main clinical manifestations of hyperparathyroidism is bone disease.…”

Brown tumors of the anterior skull base as the initial manifestation of true normocalcemic primary hyperparathyroidism: report of three cases and review of the literature

“…Approximately 15% to 20% of patients have a pathological process (hyperplasia) involving all four parathyroid glands (9,12,21,25).…”

“…It is generally classified into primary, secondary, and tertiary depending on its etiology (1,12,21). Primary HPT is usually due to a single parathyroid adenoma (5,9,12,21).…”

“…The main challenge in diagnosing brown tumor is that it can be added. Compressive lesions with neural compromise, functional problem and fracture may require early surgical removal (1,2,5,9,10,12,(21)(22)(23)25). Sometimes, surgery is indicated for definitive tissue diagnosis.…”