Sixty‐Two‐Year‐Old Male Suffering From Uremic Leontiasis Ossea Caused by Severe Secondary Hyperparathyroidism

Purrunsing, Yogendranath; Zhang, Jingjing; Cao, Ying; Liu, Wei; Xu, Yi; Hong, Xiangfei; Xing, Changying; Zhang, Xiaoming; Wang, Ningning

doi:10.1002/jbm4.10038

Cited by 5 publications

(7 citation statements)

References 27 publications

(47 reference statements)

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“…For clinical purposes, CT and NM bone scans were deemed sufficient to assess the extent of our patients' condition. Classic findings, on CT imaging, seen in patients with ULO are hypertrophy and hyperostosis of maxillary bone, possible obliteration of the maxillary sinuses as well as diffuse enlargement of the mandible [6][7][8]. CT findings found in our patient fit that description as well.…”

Section: Discussionsupporting

confidence: 83%

“…NM bone scintigraphy use in ULO evaluation has been reported in a few cases and findings show increased bone reuptake demonstrating various skeletal characteristics of renal osteodystrophy [6][7][8][9]. Our bone scintigraphy showed the same findings as well.…”

Section: Discussionsupporting

confidence: 78%

“…Patients present with enlarged mandible and maxilla and other cranial bone distortions [6,7]. Besides the obvious disfigurement of the patient, structural changes of the craniofacial bones can lead to multiple complications.…”

Section: Discussionmentioning

confidence: 99%

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Uremic Leontiasis Ossea in a Patient With End-Stage Renal Disease in Hemodialysis

Nasra

Dervishi

et al. 2020

Cureus

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Uremic leontiasis ossea is a rare condition, reported in patients with severe renal disease. Patients present with progressive enlargement of facial bones-in particular, the maxillary and mandibular bones. Rarity of this condition leaves clinicians puzzled on initial evaluation and management. Herein, we present a 31year-old man diagnosed with uremic leontiasis ossea. The report aims to review the pathophysiology of the condition as described in the literature, the patient presentation and imaging modalities used to investigate, and classical findings seen in patients with uremic leontiasis ossea. Finally, we briefly touch base on the reported regimens used to prevent and manage this condition.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 78%

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Uremic Leontiasis Ossea in a Patient With End-Stage Renal Disease in Hemodialysis

Nasra

Dervishi

et al. 2020

Cureus

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“…Treatment with parathyroidectomy only rarely leads to improvement in bone deformities [21, 22]. Most often it will at least offer stabilization of the condition [14, 23, 24, 25]. We hypothesize here that the concurrent presence of severe vitamin C deficiency in our patient was a potentiating factor for the development of such severe HPT and renal osteodystrophy.…”

Section: Discussionmentioning

confidence: 87%

Uremic leontiasis ossea due to secondary hyperparathyroidism complicated by vitamin C deficiency in a non-adherent chronic hemodialysis patient: A case report

Massicotte‐Azarniouch¹,

McLean

Brown³

2019

CNCS

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Non-adherence to medical therapy in patients with end-stage kidney disease (ESKD) can lead to severe metabolic derangements rarely seen in the current medical era. Such complications may take the form of secondary hyperparathyroidism (HPT) leading to rare manifestations of bone mineral disease, and profound vitamin C deficiency from poor nutrition combined with removal of water-soluble vitamins during dialysis. Secondary HPT causes renal osteodystrophy which can lead to diffuse enlargement of the facial skeleton and morphological changes suggestive of leontiasis ossea. We report a 36-year-old, non-adherent woman on chronic dialysis for over 10 years who developed progressive, diffuse facial bone enlargement in the context of years of extreme HPT and newly diagnosed severe vitamin C deficiency. Imaging revealed diffuse hypertrophy of the maxillary and mandibular bones. Histopathology showed extensive fibro-osseous proliferation without evidence of Brown tumor, suggestive of uremic leontiasis ossea. In this report, we discuss the orofacial manifestations of secondary HPT and the possible potentiating role of vitamin C deficiency on the development of renal osteodystrophy through altered vitamin D metabolism. Non-adherent patients on chronic dialysis should be evaluated for vitamin C deficiency, and the development of uremic leontiasis ossea should be considered when such patients present with distortion of facial features in the context of severe secondary HPT.

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“…Osteoclasts are enhanced through the actions of multiple systems such as the skeletal system, urinary system, and digestive system; this can eventually cause a variety of bone diseases and pathological fractures. 3 We herein report a case of severe bone disease caused by PHPT. Relevant studies were also reviewed to provide insight with respect to clinical practice.…”

Section: Introductionmentioning

confidence: 92%

Severe bone disease caused by primary hyperparathyroidism: a case report and review of the literature

Wang

Liu

2020

J Int Med Res

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Bone disease is an important complication of hyperparathyroidism. We herein report a rare case of severe bone disease caused by primary hyperparathyroidism. A 33-year-old man presented with pain and restricted mobility in his right upper limb and right hip due to a fall 3 days previously. X-ray examination showed a fracture of the proximal and distal humerus. Computed tomography examination showed a supracondylar fracture of the right humerus, a fracture of the right femoral neck, a fracture of the right sciatic branch, and multiple brown tumors. Ultrasonography showed a 3.5- × 1.6-cm hypoechoic mass below the left lobe of the thyroid. The patient was diagnosed with primary hyperparathyroidism based on increased serum calcium and parathormone concentrations, pathological fractures, and multiple brown tumors. He therefore underwent bilateral lower parathyroidectomy. Pathological examination revealed a parathyroid adenoma. The patient recovered well after surgery and was followed up for 6 months with no symptoms of hyperparathyroidism. This case report suggests that clinicians should be aware of the possibility of severe bone disease secondary to primary hyperparathyroidism. Active and early diagnosis and surgical treatment are important in such cases.

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Sixty‐Two‐Year‐Old Male Suffering From Uremic Leontiasis Ossea Caused by Severe Secondary Hyperparathyroidism

Cited by 5 publications

References 27 publications

Uremic Leontiasis Ossea in a Patient With End-Stage Renal Disease in Hemodialysis

Uremic Leontiasis Ossea in a Patient With End-Stage Renal Disease in Hemodialysis

Uremic leontiasis ossea due to secondary hyperparathyroidism complicated by vitamin C deficiency in a non-adherent chronic hemodialysis patient: A case report

Severe bone disease caused by primary hyperparathyroidism: a case report and review of the literature

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