Upper alveolar brown tumor as initial presentation of parathyroid adenoma

Abstract

Parathyroid adenoma usually presents with the signs and symptoms of hypercalcemia due to hyperparathyroidism. Brown's tumor is the late clinical consequence of untreated hyperparathyroidism and is rarely seen now-a-days due to improved screening biochemical tests. These tumors are characterized by high orthoclastic activity and bone resorption. These are usually located in the pelvis, ribs, clavicles, and extremities. This manuscript highlights a rare presentation of brown's tumor of upper alveolus in a 35-year-old female with a previously undiagnosed case of hyperparathyroidism due to a parathyroid adenoma. Blood analysis depicted high levels of serum calcium and parathyroid hormone. The patient was subjected to selective left lower parathyroidectomy and will receive follow-up to prevent further developments of the disease. Clinicians should be aware of such rare presentation of parathyroid adenomas so that unnecessary extensive surgery of brown's tumor is avoided. This case also highlights the need of detailed work up to arrive at an exact diagnosis and direct surgical intervention to the adenoma rather the secondary manifestation of the disease.

Denosumab-related osteonecrosis of the jaw: A literature review

“…8,10,12 In our patient, the time interval between first symptoms, excision of a giant cell tumor of the clavicle and diagnosis of primary hyperparathyroidism was 24 and 12 months, respectively. Therefore, we conclude that a correct diagnosis of craniofacial brown tumors facilitates a timely diagnosis of primary hyperparathyroidism.…”

“…14,16,19 The management of brown tumors remains controversial, but the prevailing scheme includes parathyroidectomy, long-term monitoring of osteolytic lesions and, in the case of nonresponse and/or discomfort, the surgical removal of the tumor. 9,10,12 It has also been argued that expansive growth requires lesion resection followed by a parathyroidectomy. 4,8,17 Other authors described conservative treatment of central giant cell granulomas with intralesional injections of corticosteroids for 6 weeks.…”

“…13 A histology report must therefore be confronted with the results of a clinical examination, laboratory tests and diagnostic imaging. 8,10,17 Radiological findings tend to be noncharacteristic. Differential diagnosis includes other osteolytic lesions, most frequently solitary, with cortical thinning and tooth apex resorption, similar to odontogenic cysts and tumors.…”

“…It is more common in women in the 4 th and 5 th decades of life. 4,[8][9][10]12,14 In younger people, brown tumor has been reported in multiple endocrine neoplasia syndromes (MEN1 and MEN2A). [4][5][6]14,15 Pregnancy has not been associated with brown tumor.…”

“…1,[3][4][5][6][7][8][9] Parathyroidectomy is the treatment of choice for symptomatic and progressive PHPT. [9][10][11] Multifocal brown tumors are a rare complication of hyperparathyroidism. The reported prevalence of PHPTrelated brown tumor is 3-4%.…”