Multiple Brown Tumors Caused by Primary Hyperparathyroidism as a Differential Diagnosis to Multiple Osteolytic Bone Metastases: A Case Report

Zeina Hadad, Louise Tjelum, Pia Eiken, Waldemar Trolle, Ilia Haupter, Pia Afzelius

Abstract


Brown tumors are benign osteolytic lesions, which usually respect the bone cortex. Since these lesions may resemble bone metastases, it is important to consider them as a potential differential diagnosis. They occur as a result of increased parathyroid hormone (PTH) secretion mainly due to primary or secondary hyperparathyroidism. We present a case of multiple osteolytic lesions incidentally found on X-ray examinations in a patient, who had a radius fracture after a low-energy trauma. Due to the suspicion of multiple bone metastases, one of them mimicking sequels after a pathological fracture in the ulna, the patient had a positron emission tomography/computed tomography (PET/CT) and a magnetic resonance imaging (MRI) scan performed supporting the existence of pervasive bone lesions without suggesting a primary malignancy. The blood samples showed highly elevated ionized calcium and PTH levels. Therefore, an ultrasound examination and parathyroid scintigraphy were performed, revealing a hyperfunctioning parathyroid adenoma. After removal of the adenoma, the PTH level normalised and the bone changes regressed without surgical intervention.




J Endocrinol Metab. 2020;10(3-4):94-100
doi: https://doi.org/10.14740/jem637

Keywords


Primary hyperparathyroidism; Parathyroid adenoma; Brown tumors; Metastasis; Osteolytic bone lesions

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