Unusual Spinal Manifestation in Secondary Hyperparathyroidism

Jackson, Wes; Sethi, Anil; Carp, Julia; Talpos, Gary B.; Vaidya, Rahul

doi:10.1097/brs.0b013e3181453f85

Cited by 29 publications

(47 citation statements)

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“…BT occurs mostly as isolated masses, but disseminated ones mimicking metastases have also been reported. [5111213171819] Joyce et al . [20] were the first who reported multiple BTs in primary hyperparathyroidism due to adenoma mimicking metastasis in 1994.…”

Section: Discussionmentioning

confidence: 99%

Brown tumor as an unusual but preventable cause of spinal cord compression: Case report and review of the literature

et al. 2014

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Brown tumor (BT), also known as osteoclastoma, may appear in the context of primary and secondary hyperparathyroidism. Spinal cord compression due to the BT is extremely rare. We present here an unusual case of BT involving thoracal spine and mandible. A 26-year-old woman, who had been on hemodialysis for chronic renal failure for over 6 years, got admitted with dorsal pain and progressive weakness in her lower extremities and gait disturbances. Neurological examination revealed spastic paraparesis and symmetrically hyperactive tendon reflex in the lower extremities. She had hypoesthesia under T10 level. On physical examination, a swelling on the left side of her jaw was also detected. Magnetic resonance imaging (MRI) showed cord compression due to an extradural mass lesion at T8 level. A computerized tomography (CT) scan showed that this expansile lytic lesion was caused by the collapse of vertebra corpus (T8) at that level. CT of the mandible revealed an expansile lytic lesion on left arm of the mandible. Laboratory findings were nearly normal except parathormone level elevation to 1289 pg/mL (normal 30-70 pg/mL). Ultrasound examination showed enlargement of the parathyroid glands. The patient underwent an emergency decompression and stabilization surgery. The lesion was fragile and reddish in appearance and was easy to aspirate. The tumor was reported as “BT.” Her weakness in the lower extremities improved in the early postoperative period. Following surgical intervention, the patient was transferred to nephrology clinic for additional medical treatment.

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Section: Discussionmentioning

confidence: 99%

Brown tumor as an unusual but preventable cause of spinal cord compression: Case report and review of the literature

et al. 2014

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“…We stress the importance of including UTC in the differential diagnosis when managing a patient who may have an underlying metabolic disturbance. 9 The cornerstone of medical therapy is correcting the underlying calcium and phosphate elevations. The 2005…”

Section: Discussionmentioning

confidence: 99%

Uremic tumoral calcinosis in the cervical spine: case report

Fatehi

Ahuja

Wang

et al. 2016

SPI

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Tumoral calcinosis is an uncommon condition characterized by the calcification of periarticular soft tissue. In uremic patients the disease is secondary to metabolic disturbances in predisposed patients. The authors report the case of a 73-year-old woman who presented with a new painful cervical mass while undergoing continuous ambulatory peritoneal dialysis for long-standing end-stage renal disease (ESRD). A CT scan of the neck showed a lobulated, calcified mass in the left paraspinal soft tissue at C2–3. This mass affected the facet joint and also extended into the neural foramen but did not cause any neurological compromise. Due to the patient's significant medical comorbidities, resection was deferred and the patient was followed in the clinic. Subsequent repeat imaging has shown a significant decrease in the size of the mass. In the context of ESRD, a diagnosis of uremic tumoral calcinosis (UTC) was made. The authors conducted a search of the PubMed and EMBASE databases and identified 7 previously reported cases of UTC of the cervical spine. They present a summary of these cases and discuss the etiology, diagnosis, and management of the condition. Although the metabolic disturbances seen in patients undergoing dialysis can lead to tumoral calcinosis, most reported cases involve large joints such as the shoulder or the hip; however, the spine can also be affected and should be considered in the differential diagnosis of patients with uremia as it can mimic aggressive bone-forming neoplasms.

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“…3,5 It has va ri o us cli ni cal ma ni fes ta ti ons and may pri ma rily af fect kid ney, ske le tal system and the gas tro in tes ti nal tract. 4 Symptoms du e to hyper cal ce mi a such as drow si ness, anore xi a, ab do mi nal pa in, cons ti pa ti on, na u se a, and vo mi ting, as well as re nal cal cu li are com mon.…”

Section: Discussionmentioning

confidence: 99%

“…3 Spi nal compli ca ti on of both pri mary and se con dary hyper parath yro i dism is rase and af fects 15% and 13% of the pa ti ents, res pec ti vely. 5 Ra di o lo gi cal fe a tu res of mul tip le bo ne le si ons may so me ti mes mi mic multip le me tas ta tic tu mors and sug gest the ter mi nal sta ge of a ma lig nancy. 3 In vol ve ment of the spi ne with ne u ral com pres si on is very ra re.…”

Section: Ayirici Tanimentioning

confidence: 99%

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Primary Hyperparathyroidism: A Rare Cause of Spinal Cord Compression: Differential Diagnosis

Onbaşı¹,

Kebapçı²,

Efe³

et al. 2010

Turkiye Klinikleri J Med Sci

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rimary hyperparathyroidism (PHPT) is a calcium metabolism disorder caused by overproduction of parathyroid hormone (PTH) by the parathyroid glands.1,2 It is characterized with elevated serum calcium and alkaline phosphatase and low phosphorus levels. 3 In symptomatic patients, dysfunction of CNS, peripheral nerves and/or muscles, gastrointestinal tract and/or joints may occur. Differential Diagnosis A AB BS S T TR RA AC CT T A 66-ye ar-old wo man was ad mit ted to our hos pi tal with dif fi culty in wal king. Magne tic re so nan ce ima ging re ve a led mass le si ons at T2-T3 ver teb rae causing de vi a ti on of the spi nal cord. The positron emission tomography (PET) scan of the body sho wed a hyper me ta bo lic sta te in the right ma xil lary si nus and mul tip le me tas ta tic le si ons in the ske le tal system in di ca ting a me tasta tic tu mor of uni den ti fi ed ori gin. The pa ti ent was ope ra ted im me di a tely for cord com pres si on that co uld le ad to a ne u ro lo gi cal problem. Pat ho lo gi cal exa mi na ti on of the ope ra ti on spe ci men was consis tent with a gi ant cell tu mor. The pa ti ent's se rum cal ci um le vel was ele va ted (11.6 mg/dL; re feren ce li mits: 8.5-10.5) and phosp ho rus le vel was be low the nor mal ran ges. Parathyroid hormone was ex tre mely high; 2097 pg/mL (re fe ren ce li mits: 15-65 pg/mL). So nog rap hic exa mi na ti on of the neck re ve a led mul ti no du lar go i ter and a le si on at the in fe ri or re gi on of the right thyro id lo be sug ges ting a pa rath yro id ade no ma. Ske le tal X-rays sug ges ted Brown tu mors of long bo nes. The ca se was di agno sed as pri mary hyper pa rath yro i dism and was re fer red for pa rath yro i dec tomy.K Ke ey y W Wo or rd ds s: : Hyper pa rath yro i dism, pri mary; spi nal cord com pres si on; hyper cal ce mi a, gi ant cell tu mors Ö ÖZ ZE ET T 66 ya şın da ba yan has ta has ta ne mi ze yü rü me de zor lan ma ya kın ma sı ile ya tı rıl dı. Çe ki len manyetik rezonans gö rün tü le me sin de T2-3 omur lar se vi ye sin de kit le lez yon la rı iz len di. Bu lez yonlar spi nal kord üze rin de de vi as yo na se bep ol mak tay dı. Ya pı lan pozitron emisyon tomografi (PET) gö rün tü le me de sağ mak sil ler si nüs te hi per me ta bo lik ak ti vi te ve is ke let sis te min de ise çok odak lı me tas ta tik lez yon lar tes pit edil di. Bul gu lar oda ğı bi lin me yen bir tü mör me tas ta zı nı dü şün dür mektey di. Si nir do ku su ba sı sı nın nö ro lo jik se kel ge liş tir me ris ki ne de niy le has ta aci len ame li yat edil di. Ope ras yon ma ter ya li nin pa to lo jik in ce le me si dev hüc re li tü mör ile uyum luy du. Has ta nın se rum kal si yum dü zey le ri (11.6 mg/dL; nor mal sı nır: 8.5-10.5 mg/dL) yük sel miş, fos for dü zey le ri ise azalmış ola rak bu lun du. Paratiroid hormon dü ze yi (2097 pg/mL; nor mal sı nır: 15-65 pg/mL) çok yük -sek ti. So nog ra fik in ce le me sin de mul ti no du ler gu atr ile sağ ti ro id be zi in fe ri or ke si min de bir lez yon tes pit edil di. İske let sis te mi direkt grafi in ce le...

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Unusual Spinal Manifestation in Secondary Hyperparathyroidism

Abstract: Hyperparathyroidism may cause tumoral calcinosis-like lesions in the spine. An early spinal decompression followed with parathyroidectomy leads to remission of symptoms.

Cited by 29 publications

References 10 publications

Brown tumor as an unusual but preventable cause of spinal cord compression: Case report and review of the literature

Brown tumor as an unusual but preventable cause of spinal cord compression: Case report and review of the literature

Uremic tumoral calcinosis in the cervical spine: case report

Primary Hyperparathyroidism: A Rare Cause of Spinal Cord Compression: Differential Diagnosis

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