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Diffuse Calvarial Hyperstosis
Ali Alkhaibary1, Ahoud Alharbi1, Sami Khairy1
1College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia.
Insights
Diffuse calvarial hyperostosis, a bone thickening condition, was observed in a patient with end-stage renal disease and tertiary hyperparathyroidism. This case highlights the bone abnormalities associated with metabolic disorders.
Area of Science:
- Nephrology
- Endocrinology
- Radiology
Background:
- Calvarial hyperostosis can be idiopathic or secondary to metabolic conditions.
- End-stage renal disease (ESRD) and tertiary hyperparathyroidism are significant metabolic pathologies.
- Brown tumors are a manifestation of severe hyperparathyroidism.
Observation:
- A 26-year-old male with ESRD, tertiary hyperparathyroidism, and skeletal deformities presented with macrocephaly.
- Clinical examination revealed frontal bossing and developmental delays.
- Imaging showed diffuse calvarial and facial bone hyperostosis with sclerotic/lytic lesions.
Findings:
- Computed tomography (CT) revealed diffuse calvarial hyperostosis and facial bone expansion.
- CT demonstrated narrowing of basilar skull foramina due to bone lesions.
- Magnetic resonance imaging (MRI) showed expansile bone marrow abnormalities in the skull base and calvarium.
Implications:
- The findings correlate with the patient's hypermetabolic state and tertiary hyperparathyroidism.
- This case underscores the complex skeletal manifestations in patients with ESRD and secondary hyperparathyroidism.
- Conservative management with regular follow-up was initiated for this rare presentation.
Abstract:
Calvarial hyperstosis can be an idiopathic benign finding or secondary to a metabolic pathology. We herein describe a case of diffuse calvarial hyperstosis. A 26-year-old man known to have end-stage renal disease on regular hemodialysis, tertiary hyperparathyroidism, extensive brown tumors, and severe developmental impairment with skeletal deformities was referred to us for macrocephaly. On examination, the patient was chairbound, with speech and motor developmental delay, and frontal bossing. Brain computed tomography revealed diffuse hyperstosis of the calvarium and facial bones expansion with multiple sclerotic and lytic areas, causing subsequent narrowing of the basilar skull foramina. Brain magnetic resonance imaging demonstrated an extensive expansile bone marrow abnormality in the calvarium and skull base. There was mild generalized prominence of cortical sulci and ventricular system. The findings were in keeping with his known hypermetabolic state and tertiary hyperparathyroidism. The patient was managed conservatively with regular follow-up in the clinic.
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