Multiple brown tumors in a patient with nutritional secondary hyperparathyroidism

Abstract

For years, brown tumors have been considered to be a characteristic of primary hyperparathyroidism. However, since 1963 several reports indicate the incidence of brown tumors in patients with renal secondary hyperparathyroidism to be 1.5%-1.7%. The appearance of multiple brown tumor lesions is rather uncommon in secondary hyperparathyroidism which is also true for malabsorption as its cause. We report on a 56-year-old man presenting with pain in the bones and multiple osteolyses. A bone biopsy specimen and the laboratory examinations were indicative of secondary hyperparathyroidism caused by malabsorption most likely due to Billroth's II/I gastric resection. Thus, the patient's osteolyses represent brown tumors which have been induced by nutritional secondary hyperparathyroidism.

Oral manifestations of secondary hyperparathyroidism: A case report

“…The frequency of brown tumors in secondary HPT is 1.5–1.75. [ 7 8 ] Present case showed multilocular lesions in posterior mandibular body regions along with bicortical expansion of both the jaws.…”

A Brown Tumor after Biliopancreatic Diversion for Severe Obesity

“…Other possible causes of lytic bone lesions such as metastatic tumors, fibroma and reticuloendothelioma should be excluded. In addition, brown tumors due to malabsorption and secondary hyperparathyroidism were described in four cases, one after gastric resection (Billroth I/II) [1], another with progressive systemic sclerosis [10], and two in patients with gluten enteropathy [11,12].…”

“…Brown tumors are welldefined, often expansive, solitary or multifocal lytic bone lesions. Most commonly they are localized in the mandible, ribs, pelvis an femora, although they can involve all parts of the skeleton [1,2]. Brown tumors have been considered characteristic of primary hyperparathyroidism but are now diagnosed less frequently because of earlier diagnosis and treatment of patients with primary hyperparathyroidism.…”

“…More recently brown tumors have been more frequently observed in patients with secondary hyperparathyroidism induced by chronic renal failure [3,4]. Reports on nutritional secondary hyperparathyroidism and brown tumors are far less common [1].…”

Brown tumour as a complication of secondary hyperparathyroidism in severe long-lasting vitamin D deficiency rickets

“…Brown tumour of secondary hyperparathyroidism induced by anticonvulsant medications was described in an adult patient who responded to vitamin D treatment [2]. Brown tumour of secondary hyperparathyroidism due to malabsorption was described in two cases, one with gastric resection and the other with progressive systemic sclerosis [12,14]. In developing countries, vitamin D de®ciency rickets is among the leading causes of secondary hyperparathyroidism.…”