Brown tumor of the jaws as a manifestation of tertiary hyperparathyroidism: A literature review and case report

Santos, Bethina dos; Koth, Valesca Sander; Figueiredo, Maria Antonia Zancanaro de; Salum, Fernanda Gonçalves; Cherubini, Karen

doi:10.1111/scd.12284

Cited by 30 publications

(55 citation statements)

References 48 publications

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“…[8,11] Prevalence in patients with tertiary HPT is unknown and has rarely been reported. [10,[12][13][14][15][16] Our systematic review of the medical literature yielded 95 cases (published from 1962 through 2020) of craniofacial brown tumors. Table 2 summarizes the results of the literature review.…”

Section: Craniofacial Brown Tumormentioning

confidence: 99%

Three Rare Concurrent Complications of Tertiary Hyperparathyroidism: Maxillary Brown Tumor, Uremic Leontiasis Ossea, and Hungry Bone Syndrome

et al. 2020

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A 48-year-old woman in her 40' s with end-stage renal disease and tertiary hyperparathyroidism (HPT) presented for a rapidly progressive maxillary tumor. Initial workup was notable for elevated intact parathyroid hormone (PTH) and diffuse thickening of skull and facial bones on computed tomography, and maxillary tumor biopsy with multinucleated giant cells. She underwent subtotal parathyroidectomy (with removal of a parathyroid adenoma and 2 hyperplastic glands) and partial resection of maxillary brown tumor. The patient's post-operative course was complicated by hungry bone syndrome, with hypocalcemia refractory to aggressive calcium repletion. Teriparatide (recombinant PTH) was utilized with rapid resolution of hypocalcemia. To our knowledge, this is the first case of maxillary brown tumor in tertiary HPT to be reported in the USA. This case also supports teriparatide as a novel therapeutic for hungry bone syndrome refractory to aggressive calcium repletion.

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Section: Craniofacial Brown Tumormentioning

confidence: 99%

Three Rare Concurrent Complications of Tertiary Hyperparathyroidism: Maxillary Brown Tumor, Uremic Leontiasis Ossea, and Hungry Bone Syndrome

et al. 2020

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“…In addition, decreased activation of Vitamin D in the kidney leads to increased PTH secretion. Excess PTH leads to unbalanced increased activity of osteoclasts and osteoblasts which results in increased unmineralized bone contributing to the ULO; the same pathogenesis is seen in renal osteodystrophy [2,4,5].…”

Section: Discussionmentioning

confidence: 95%

“…ESRD patient's non-adherent to the hemodialysis regimen and medical treatment are likely most susceptible to uremic leontiasis ossea. Such non-compliance to hemodialysis is also seen in our ESRD patient, leading up to his ULO presentation due to possible chronic metabolic derangements and secondary hyperparathyroidism [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

Uremic Leontiasis Ossea in a Patient With End-Stage Renal Disease in Hemodialysis

Nasra

Dervishi

et al. 2020

Cureus

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Uremic leontiasis ossea is a rare condition, reported in patients with severe renal disease. Patients present with progressive enlargement of facial bones-in particular, the maxillary and mandibular bones. Rarity of this condition leaves clinicians puzzled on initial evaluation and management. Herein, we present a 31year-old man diagnosed with uremic leontiasis ossea. The report aims to review the pathophysiology of the condition as described in the literature, the patient presentation and imaging modalities used to investigate, and classical findings seen in patients with uremic leontiasis ossea. Finally, we briefly touch base on the reported regimens used to prevent and manage this condition.

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“…This finding was significantly more common in liver cirrhosis patients than in healthy individuals. PTH disturbances and secondary hyperparathyroidism can cause radiolucent jaw lesions referred to as “Brown Tumors” [ 29 ]. Although vitamin D levels are decreased in liver cirrhosis patients, secondary hyperparathyroidism is found to be relatively uncommon [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Osteoporosis and Jaw Abnormalities in Panoramic Radiography of Chronic Liver Failure Patients

Ghapanchi

Zahed

Haghnegahdar

et al. 2018

BioMed Research International

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Introduction Patients with chronic liver failure (CLF) are faced with many complications, because this organ is involved in various metabolic activities. Hepatic osteodystrophy is one of the major health issues encountered by this group of patients. The current study evaluated osteoporosis and bone changes in oral panoramic radiographies of cirrhotic patients. Materials and Methods In this study, 138 panoramic views of CLF patients, candidates for liver transplant (65 females, 73 males, aged 19-68 years) referred to Shiraz University Dental Clinic (Shiraz, Iran) for pretransplant oral examination, were evaluated. Also 138 healthy individuals (69 females, 69 males, aged 18-70 years) referred to the same clinic were examined. Abnormalities such as osteoporosis, pathologic radiolucencies, pathologic calcifications, tonsilloliths, condylar degeneration, and other findings in the alveolar bones were recorded. ResultsOsteoporosis was a common finding in CLF patients (p<0.001), and the probability of detecting low bone density in the panoramic view was 20.37 times higher among patients than healthy subjects. The probability of detecting pathologic jaw radiolucencies was 8.92 times higher in the case group than in the controls (p<0.001). Other bone abnormalities such as condylar degeneration and idiopathic osteosclerosis were also more prevalent in CLF patients compared to healthy subjects (p<0.001). Conclusion Cirrhotic patients are prone to osteoporosis of the alveolar bones. Also, pathologic jaw radiolucencies as a result of oral infections are more prevalent in this group of patients. Routine oral panoramic views are acceptable and cost-effective radiographies for use in detecting such abnormalities in the alveolar bones as well as overall dental health. These findings also support the importance of dental health examinations prior to liver transplantation to reduce the risk of organ rejection.

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Brown tumor of the jaws as a manifestation of tertiary hyperparathyroidism: A literature review and case report

Cited by 30 publications

References 48 publications

Three Rare Concurrent Complications of Tertiary Hyperparathyroidism: Maxillary Brown Tumor, Uremic Leontiasis Ossea, and Hungry Bone Syndrome

Three Rare Concurrent Complications of Tertiary Hyperparathyroidism: Maxillary Brown Tumor, Uremic Leontiasis Ossea, and Hungry Bone Syndrome

Uremic Leontiasis Ossea in a Patient With End-Stage Renal Disease in Hemodialysis

Osteoporosis and Jaw Abnormalities in Panoramic Radiography of Chronic Liver Failure Patients

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