Primary hyperparathyroidism presenting as a palatal and mandibular brown tumor

Area of Science:

• Endocrinology
• Oncology
• Skeletal Biology

Background:

• Primary hyperparathyroidism (PHP) is a common endocrine disorder caused by excessive parathyroid hormone secretion, typically from parathyroid adenomas.
• While hypercalcemia is the most frequent clinical manifestation, PHP can present with rarer skeletal complications like brown tumors and osteitis.
• Skeletal manifestations of PHP have become less common due to early diagnosis of asymptomatic hypercalcemia.

Purpose of the Study:

• To present a rare case of primary hyperparathyroidism manifesting with significant skeletal involvement, including brown tumors in the maxilla, palate, and mandible.
• To emphasize the diagnostic process and successful management of a complex case involving multiple complications potentially linked to PHP.
• To underscore the importance of considering PHP in the differential diagnosis of unexplained bone lesions and fractures.

Main Methods:

• Case report detailing clinical history, biochemical assays, radiological imaging (including CT/MRI), and histopathological examination.
• Surgical management involving excision of a parathyroid adenoma.
• Post-operative monitoring of metabolic status and clinical follow-up.

Main Results:

• The patient presented with brown tumors of the jaw, a history of nephrectomy, and a proximal femur fracture, suggestive of advanced PHP.
• Biochemical and histopathological findings confirmed the diagnosis of primary hyperparathyroidism and brown tumors.
• Excision of the parathyroid adenoma led to normalization of metabolic status and resolution of symptoms.

Conclusions:

• Primary hyperparathyroidism, though often asymptomatic, can present with severe skeletal manifestations like brown tumors, even in the contemporary diagnostic era.
• Multidisciplinary diagnostic approaches are crucial for identifying PHP and its complications.
• Surgical treatment of the underlying parathyroid adenoma is effective in resolving metabolic abnormalities and improving skeletal health.