Osteolytic lesions: osteitis fibrosa cystica in the setting of severe primary hyperparathyroidism

Abstract

A 58-year-old female patient presented with several weeks history of significant bilateral knee pain. Initial knee radiographs demonstrated lucencies of the bony cortex while extensive osteolytic lesions on a routine chest radiograph were suggestive of multiple myeloma or bony metastases. Biochemical investigation revealed primary hyperparathyroidism with renal insufficiency. A parathyroid adenoma was demonstrated on a neck ultrasound and sestamibi scan and subsequently confirmed by histology. We illustrate a case of primary hyperparathyroidism with osteitis fibrosa cystica and brown tumours which were initially mistaken for malignant disease.

Fatal Hypocalcaemia Due to Hungry Bone Syndrome with Secondary Refractory HyperParathyroidism after Parathyroidectomy: A Case Report

“…In the case described here, there were no X-rays on admission to objectify these signs, but patient described multiple fractures in the disease's history. High levels of preoperative serum AlkPhos is also considered a predictive factor for parathyroid-related bone disease and therefore for HBS [16]; our patient's preoperative serum level of AlkPhos was 376 U/L (nv: 40-150 U/L). There are also other risk factors for HBS, which were noted in this case: high values of preoperative serum iPTH, older age, the increased volume and weight of resected parathyroid glands.…”

“…The literature describes several risk factors for HBS [2]. Among these factors, most authors agree that the presence of preoperative parathyroid-related bone lesions (osteitis fibrosa cystica, brown tumours, pathologic fractures) is significantly associated with the development of postoperative HBS [15,16]. In the case described here, there were no X-rays on admission to objectify these signs, but patient described multiple fractures in the disease's history.…”

Severe Primary Hyperparathyroidism Caused by Parathyroid Carcinoma in a 13‐Year‐Old Child; Novel Findings From HRpQCT

“…This difference could be explained by the fact that the cortex may be more metabolically active in children, especially during pubertal phases such as in the case of our patient, wherein the evolution of cortical porosity is an adaptation mechanism to maintain mechanical strength. In both studies, there was no report of any osteolytic lesions, which may also be explained by this mechanism, but is most likely caused by the higher PTH levels attributed to the carcinoma versus parathyroid adenomas noted in published adult studies …”

“…In both studies, (33,34) there was no report of any osteolytic lesions, which may also be explained by this mechanism, but is most likely caused by the higher PTH levels attributed to the carcinoma versus parathyroid adenomas noted in published adult studies. (39)(40)(41) It is important to note, however, that the interpretation of HRpQCT bone properties in the context of healthy controls is currently limited for the HRpQCT version 2 of the scanner. The available normative data for children in the literature have only reported results from version 1 scanners, (42) which use a slightly lower resolution (82-μm isotropic voxel size) and yield multiple parameters that are not directly measured, but are derived from bone volume fraction and trabecular density.…”

First Case of Plasma Cell Myeloma With Brown Tumor Features Unrelated to Hyperparathyroidism

“…Brown tumor (osteitis fibrosa cystica) is a benign bone tumor and metabolic bone disease induced by primary or secondary hyperparathyroidism [4567]. Radiologically, multiple lytic bone lesions are difficult to differentiate from PCM or metastatic cancer; pathologically, it is challenging to discriminate them from giant cell tumors of the bone [45678]. Therefore, calcium and parathyroid hormone (PTH) levels are essential for distinguishing brown tumors from other bone diseases associated with lytic bone lesions.…”