Jaw tumor in recurrent primary hyperparathyroidism: A case report

Area of Science:

• Endocrinology
• Oncology
• Radiology

Background:

• Brown tumors, osteolytic lesions associated with hyperparathyroidism, are rarely symptomatic due to early detection.
• Hyperparathyroidism can manifest with bone pain, expansion, or fractures, but jaw lesions are uncommon presentations.

Purpose of the Study:

• To report a rare case of a symptomatic brown tumor in the jaw in a patient with a history of hyperparathyroidism.
• To emphasize the diagnostic considerations for jaw lesions in the context of hypercalcemia and hyperparathyroidism.

Main Methods:

• A 65-year-old woman with generalized bone pain and a jaw mass was evaluated for hypercalcemia and elevated parathyroid hormone (PTH).
• Diagnostic imaging included Dual energy X-ray (DXA), MRI, and SPECT-CT with 99mTc-MIBI.
• Surgical removal of a parathyroid adenoma was performed, followed by medical management.

Main Results:

• The patient presented with hypercalcemia (PTH 398 pg/ml) and a MIBI-avid lytic lesion in the mandible.
• Post-surgery, PTH levels decreased to 57 pg/ml, with normalization of calcium levels.
• The jaw mass gradually decreased with calcium and vitamin D supplementation.

Conclusions:

• Osteolytic lesions, including jaw tumors, can be a manifestation of primary or secondary hyperparathyroidism.
• The non-specific symptoms of hypercalcemia necessitate considering bone tumors as a potential sign of underlying hyperparathyroidism.