Multiple brown tumours from parathyroid carcinoma.

Area of Science:

• Endocrinology
• Oncology
• Skeletal Radiology

Background:

• Hyperparathyroidism can lead to significant skeletal complications.
• Parathyroid carcinoma is a rare cause of severe hypercalcemia and bone disease.

Observation:

• A 29-year-old woman presented with severe bilateral inguinal pain, mandibular mass, and widespread osteolytic bone lesions.
• Imaging revealed diffuse osteopenia, kidney stones, and a thyroid mass. Elevated ionized calcium and intact parathyroid hormone (PTH) were noted.
• Biopsy of the mandibular mass showed a brown tumor, initially suggesting a benign condition.

Findings:

• Initial parathyroidectomy for a hyperfunctioning parathyroid gland revealed parathyroid carcinoma with capsular and vascular invasion.
• Post-operative PTH levels decreased significantly after tumor resection.
• Six-month follow-up demonstrated normalized calcium, reduced bone lesions, and improved quality of life.

Implications:

• This case highlights the importance of considering parathyroid carcinoma in young patients with aggressive hyperparathyroidism and skeletal metastases.
• Prompt surgical intervention is crucial for managing parathyroid carcinoma and its associated complications.
• Multidisciplinary management, including oncologic and endocrine expertise, is essential for optimal patient outcomes.