Acute neurological syndrome complicating secondary hyperparathyroidism

Area of Science:

• Nephrology
• Endocrinology
• Oncology

Background:

• Secondary hyperparathyroidism is a common complication in patients with end-stage renal disease (ESRD) on hemodialysis.
• Uncontrolled secondary hyperparathyroidism can lead to tertiary hyperparathyroidism and complications such as "brown tumors."
• Brown tumors are benign but locally aggressive neoplasms resulting from excessive osteoclast activity.

Observation:

• A young woman with ESRD on hemodialysis presented with progressive lower extremity weakness and back pain.
• Imaging revealed multiple lytic bone lesions, including a significant T3 spinal lesion causing cord compression.
• The patient's uncontrolled secondary hyperparathyroidism was the likely cause of these bone abnormalities.

Findings:

• The patient underwent urgent neurosurgical resection of the T3 spinal tumor to relieve cord compression.
• A subtotal parathyroidectomy was performed to address the underlying severe secondary hyperparathyroidism.
• Histopathological examination confirmed the diagnosis of a brown tumor.

Implications:

• This case underscores the critical importance of managing secondary hyperparathyroidism in ESRD patients to prevent severe complications.
• Prompt diagnosis and surgical intervention are crucial for managing symptomatic brown tumors, especially those causing spinal cord compression.
• Effective treatment strategies for secondary hyperparathyroidism in ESRD patients can mitigate the risk of developing such debilitating bone lesions.