Primary hyperparathyroidism presenting with a maxillary tumour and hydrocephalus

Primary hyperparathyroidism presenting with advanced bone disease is an important differential diagnosis of 'tumours' affecting the craniofacial skeleton. We describe a case of primary hyperparathyroidism presenting with a brown tumour of the maxilla causing local symptoms. Differentiation from other giant cell lesions of the maxilla is necessary. The histological and radiological features of brown tumour, non-ossifying fibroma and reparative granuloma are all similar. Differentiation relies on plasma calcium estimation and the diagnosis of hyperparathyroidism is confirmed by serum parathyroid hormone assay.