Primary hyperparathyroidism presenting with a maxillary tumour and hydrocephalus

Area of Science:

• Endocrinology
• Oral and Maxillofacial Surgery
• Oncology

Background:

• Primary hyperparathyroidism (PHPT) can manifest with significant bone disease.
• Craniofacial bone lesions, particularly giant cell lesions, require careful differential diagnosis.
• Brown tumors are a rare manifestation of hyperparathyroidism in the maxilla.

Observation:

• A case of PHPT presenting with a maxillary brown tumor causing local symptoms is described.
• Histological and radiological features of brown tumors, non-ossifying fibromas, and reparative granulomas are similar.
• Clinical presentation included local symptoms due to the maxillary lesion.

Findings:

• Brown tumors of the maxilla necessitate differentiation from other giant cell lesions.
• Plasma calcium estimation is key for differentiating PHPT from other conditions.
• Serum parathyroid hormone assay confirms the diagnosis of hyperparathyroidism.

Implications:

• Recognizing PHPT as a differential diagnosis for craniofacial 'tumors' is vital.
• Accurate differentiation of maxillary bone lesions prevents misdiagnosis and guides treatment.
• Biochemical testing (calcium and PTH) is essential for diagnosing PHPT presenting with bone disease.