Leontiasis ossea; a rare presentation of secondary hyperparathyroidism

Hoda Raffiei Jelodar,Mohammad Reza Babaei,Massoud Baghai Wadji,Maliheh Yarmohamadi

doi:10.15171/jrip.2018.69

Abstract

Leontiasis ossea is a rare presentation of renal osteodystrophy with few reports in literature. It causes severe skeletal deformity in the cranial bones. This study presents a report on a patient with advanced hyperparathyroidism with skeletal changes compatible with leontiasis ossea. The patient was a 34-year-old man with end-stage renal disease, uncontrolled hypertension, and dyspnea who was referred to our hospital. Physical examinations revealed: toggled speech (nasal speech), mouth breathing and facial change, saddle nose, nares widening, increased interdental space and mandibular enlargement. His serum intact parathyroid hormone (iPTH) level was 3199 pg/mL, Paranasal sinuses CT scan showed a significant expansion of the mandibular, maxillary and skull bones. Parathyroid sonography reported two severe hypertrophied parathyroid glands. The patient underwent total parathyroidectomy as a result of symptomatic bone involvement.

Highlights

Renal osteodystrophy or chronic kidney disease-mineral and bone disorder is a bone pathology, caused by electrolyte and endocrine derangements in chronic kidney disease [1]
There will be increase in phosphate and fibroblast growth factor 23, when glomerular filtration rate decreases below 60 cc/min, hyperparathyroidism, which causes the formation and resorption of renal osteodystrophy, will occur [2]
Paget’s disease, McCune-Albright syndrome and kidney osteodystrophy can present with these facial changes [3]

Summary

Introduction

Renal osteodystrophy or chronic kidney disease-mineral and bone disorder is a bone pathology, caused by electrolyte and endocrine derangements in chronic kidney disease [1]. Case Presentation A 34-year-old Afghan man with history of the maintenance of hemodialysis for eight years, was referred to our center with uncontrolled hypertension and dyspnea He complained of toggled speech, oral breathing, and severe headache. Four months ago, he noticed nose deformity, widening of interdental space, as well as enlargement of the maxillary and mandibular bones. In the last two months, he complained of hearing loss He had an episode of left femoral bone fracture, and right knee deformity that resulted to severe disability. On examination, he had saddle nose deformity, widening of the nares, hard palate hypertrophy, increasing interdental space

Discussion

Conclusion