Primary hyperparathyroidism and skull bone: Dicle sign

Abstract

Abstract Introduction In primary hyperparathyroidism, a brown tumor may be seen due to excessive osteoclastic activity. We will share the unusual localization of this tumor-like formation that primarily affects the lower and upper extremities. Clinical Case A 20-year-old female patient presented with complaints of weakness, headache, bone pain, and difficulty walking. He had a history of surgery for a pathological femur fracture in the past. In the evaluation, a diagnosis of primary hyperparathyroidism due to ectopic parathyroid adenoma was made. Brown tumor-like formations were also observed in the skull bone in the cranial tomography taken due to severe headache. An adenomectomy was performed on the patient whose parathyroid adenoma localization was detected in the scintigraphic examination. The patient, who developed post-operative hungry bone syndrome, was discharged approximately one month later due to the need for intravenous calcium. It lasted about one year after the patient's oral calcitriol and calcium treatment. She was followed up without treatment. At her last follow-up in June 2022, calcium, phosphorus, and parathormone levels were normal. The patient had no complaints. Conclusion Brown tumor is often seen in the bones of the hands, feet, and long bones. We detected it for the first time in the skull bone.