First Manifestation Of Primary Hyperparathyroidism Research Articles

Expect the unexpected: Brown tumor of the mandible as the first manifestation of primary hyperparathyroidism.

Hyperparathyroidism (HPT) is a condition in which one or more parathyroid glands produce increased levels of parathyroid hormone (PTH), causing disturbances in calcium homeostasis. Most commonly HPT presents with asymptomatic hypercalcemia but the clinical spectrum may include disturbances reflecting the combined effects of increased PTH secretion and hypercalcemia. Brown tumors are rare, benign, tumor-like bone lesions, occurring in 1.5% to 4.5% of patients with HPT, as a complication of an uncontrolled disease pathway, and are nowadays rarely seen in clinical practice. The tumor can appear either as a solitary or multifocal lesion and usually presents as an asymptomatic swelling or a painful exophytic mass. Furthermore, it can cause a pathological fracture or skeletal pain and be radiologically described as a lytic bone lesion. The diagnosis of a brown tumor in HPT is typically confirmed by assessing the levels of serum calcium, phosphorus, and PTH. Although when present, brown tumor is quite pathognomonic for HPT, the histologic finding often suggests a giant cell tumor, while clinical presentation might suggest other more frequent pathologies such as metastatic tumors. Treatment of brown tumors frequently focuses on managing the underlying HPT, which can often lead to regression and resolution of the lesion, without the need for surgical intervention. However, in refractory cases or when dealing with large symptomatic lesions, surgical treatment may be necessary.

Rare Case of a Peripheral Giant Cell Granuloma of the Jaw as First Manifestation of Primary Hyperparathyroidism.

Giant cell granulomas (GCG) are uncommon benign tumor-like lesions mostly arising in the oro-facial area. They are more common in women and occur in patients younger than 30 years. Lesions restricted to the bone are referred to as central giant cell granulomas (CGCG), and those developing primarily on soft tissues are termed peripheral giant cell granulomas (PGCG). Both types are histologically identical. The combination of both clinical examination and radiography allows for the differentiation of those two variants. On rare occasions GCG, and especially CGCG, may develop in relation to hypercalcemia linked to hyperparathyroidism (HPT). In those cases, the GCG treatment prognosis is closely linked to the HPT management. Therefore, patients diagnosed with a GCG must be investigated to search for an HPT. Reported herein is a rare clinical case of a mandibular PGCG which led to the diagnosis of primary HPT.

Brown tumour of the mandible as the first manifestation of primary hyperparathyroidism: a case report

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Consideration of primary hyperparathyroidism in primary care

A sixty-seven-year-old female patient presented with symptomatic hypercalcemia as the first manifestation of primary hyperparathyroidism due to parathyroid adenoma. Initially the chronic hypercalcemia was investigated and then subsequent parathyroidectomy was done. She is doing very well six months following the surgery and the hypercalcemia has resolved completely. Asymptomatic hypercalcaemia due to primary hyperparathyroidism is a common condition in primary care1. Most commonly primary hyperparathyroidism is caused by a solitary parathyroid adenoma (80%), and less frequently multi-glandular adenoma, parathyroid hyperplasia or carcinoma2. Patients rarely present with symptomatic hypercalcemia (mnemonic “stones,” “bones,” “abdominal moans,” and “psychic groans”) whereas usually patients remain asymptomatic and the condition is discovered during routine checkup investigations3. The disorder can occur at any age, yet is more common in the middle age group (≥50 years). The ratio of such cases is equivalent to 1:1000 in males, whereas it is 3:1000 in the female population4.

BROWN TUMORS OF GNATHIC BONES AS THE FIRST MANIFESTATION OF PRIMARY HYPERPARATHYROIDISM

We report a case of exuberant brown tumors affecting the gnathic bones as the first manifestation of primary hyperparathyroidism (PHPT). A 34-year-old female patient presented with midfacial asymmetry caused by an 8- × 4-cm painful and bleeding swelling in the left posterior maxilla, showing progressive growth for the last 2 months. A 4- x 2-cm normal-colored swelling was also detected in the right body of the mandible. Medical history included hypertension, fever, and weight loss. Panoramic radiography showed multilocular radiolucencies, overall thinning of the inferior border of the mandible, and loss of the lamina dura. Incisional biopsy revealed central giant cell lesions, which were diagnosed as brown tumors of PHPT. High values of parathormone and alkaline phosphate were detected and microscopic diagnosis of parathyroid adenoma was established after parathyroidectomy. The patient received calcium and calcitriol supplementation. Both lesions decreased partially after 2 years of follow-up, with aesthetic surgery being planned. We report a case of exuberant brown tumors affecting the gnathic bones as the first manifestation of primary hyperparathyroidism (PHPT). A 34-year-old female patient presented with midfacial asymmetry caused by an 8- × 4-cm painful and bleeding swelling in the left posterior maxilla, showing progressive growth for the last 2 months. A 4- x 2-cm normal-colored swelling was also detected in the right body of the mandible. Medical history included hypertension, fever, and weight loss. Panoramic radiography showed multilocular radiolucencies, overall thinning of the inferior border of the mandible, and loss of the lamina dura. Incisional biopsy revealed central giant cell lesions, which were diagnosed as brown tumors of PHPT. High values of parathormone and alkaline phosphate were detected and microscopic diagnosis of parathyroid adenoma was established after parathyroidectomy. The patient received calcium and calcitriol supplementation. Both lesions decreased partially after 2 years of follow-up, with aesthetic surgery being planned.

Giant mediastinal parathyroid adenoma presenting as bilateral brown tumour of mandible: a rare presentation of primary hyperparathyroidism

Hyperparathyroidism (HPT) is becoming increasingly common endocrinopathy in clinical practice. Nowadays, it is mostly diagnosed in subclinical or early clinical stage. Bony involvement in HPT has seen significant fall in...

Acute necrotizing pancreatitis as first manifestation of primary hyperparathyroidism

Acute necrotizing pancreatitis as first manifestation of primary hyperparathyroidism

A Rare Case of Parathyroid Adenoma Presenting As Acute Pancreatitis

Acute pancreatitis as a first manifestation of primary hyperparathyroidism (PHPT) caused by parathyroid adenoma is exceptionally rare. A 24 year old female presented with pain in the left side of chest , upper abdomen and breathlessness. Laboratory studies showed elevated levels of calcium, amylase, lipase and parathormone. She was found to have associated gall stones, pancreatic and renal medullary calcifications and also left sided pleural effusion. Tc 99m scan showed increased activity of right inferior parathyroid gland. The patient underwent surgical resection of the functioning parathyroid adenoma. Although the actual causal relationship between hypercalcemia and pancreatitis has been a persistent topic of debate, detection of hypercalcemia may be a clue to diagnose PHPT due to parathyroid adenoma.

Acute Pancreatitis as the First Manifestation of Parathyroid Adenoma

Acute pancreatitis as a first manifestation of primary hyperparathyroidism (PHPT) caused by parathyroid adenoma is exceptionally rare. A 21 year old man presented with severe abdominal pain, nausea and vomiting. Laboratory studies revealed leukocytosis of 15.3 thousand/ ? L, hemoglobin 14.4 g/dL, creatinine 1.31 mg/dL, amylase 1,148 IU/L, lipase 862 IU/L. Serum calcium level was 14.6 mg/dL, intact parathyroid hormone (iPTH) level was 629.6 pg/mL. Neck ultrasound showed a 1.5 × 1 × 1.1 cm solid mass at the posterior inferior aspect of the right thyroid lobe. Parathyroid scan showed a focal area of activity in the right lower lobe suggesting a parathyroid adenoma. The patient underwent parathyroidectomy and pathological examination of the parathyroid gland confirmed a parathyroid adenoma. Although the actual causal relationship between hypercalcemia and pancreatitis has been a persistent topic of debate, detection of hypercalcemia may be a clue to diagnose PHPT due to parathyroid adenoma. After aggressive medical management of acute pancreatitis, parathyroidectomy may improve clinical outcome and prevent further recurrences of pancreatitis. doi: http://dx.doi.org/10.4021/jem114w

Acute Pancreatitis as the First Manifestation of Parathyroid Adenoma

Acute pancreatitis as a first manifestation of primary hyperparathyroidism (PHPT) caused by parathyroid adenoma is exceptionally rare. A 21 year old man presented with severe abdominal pain, nausea and vomiting. Laboratory studies revealed leukocytosis of 15.3 thousand/ ? L, hemoglobin 14.4 g/dL, creatinine 1.31 mg/dL, amylase 1,148 IU/L, lipase 862 IU/L. Serum calcium level was 14.6 mg/dL, intact parathyroid hormone (iPTH) level was 629.6 pg/mL. Neck ultrasound showed a 1.5 × 1 × 1.1 cm solid mass at the posterior inferior aspect of the right thyroid lobe. Parathyroid scan showed a focal area of activity in the right lower lobe suggesting a parathyroid adenoma. The patient underwent parathyroidectomy and pathological examination of the parathyroid gland confirmed a parathyroid adenoma. Although the actual causal relationship between hypercalcemia and pancreatitis has been a persistent topic of debate, detection of hypercalcemia may be a clue to diagnose PHPT due to parathyroid adenoma. After aggressive medical management of acute pancreatitis, parathyroidectomy may improve clinical outcome and prevent further recurrences of pancreatitis. J Endocrinol Metab. 2012;2(4-5):187-189 doi: https://doi.org/10.4021/jem114w

A Reference Finding Rarely Seen in Primary Hyperparathyroidism: Brown Tumor

Primary hyperparathyroidism is an endocrinopathy which is characterized with the hypersecretion of parathormone. During the progress of the disease bone loss takes place due to resorption on the subperiosteal and endosteal surfaces. Brown tumor is a localized form of osteitis fibrosa cystica, being part of the hyperparathyroid bone disease. It is rarely the first symptom of hyperparathyroidism. Nowadays, the diagnosis is made at an asymptomatic or minimally symptomatic stage. We present a male patient presented with a massive painless swelling in the left maxilla as the first manifestation of primary hyperparathyroidism due to a parathyroid adenoma. Parathyroidectomy was performed, and there was a regression of the bone lesion, without the need of performing other local surgical procedures.

Brown tumor of the palate as first manifestation of primary hyperparathyroidism: a case report

Brown tumor is one of the lesions that develop in patients with hyperparathyroidism. Skeletal bones including maxillo-facial ones can be the site of this lesion. Owing to the improve methods of blood analysis most of cases of primary hyperparathyroidism are diagnosed early and asymptomatically making advanced disease with bone lesions extremely rare. This article contains a case of a 43-year-old female patient who presented with palatal swelling as the first sign of primary hyperparathyroidism. The diagnosis was suggested by the histological findings and confirmed by the endocrinologic status.

Brown tumor mimicking maxillary sinus mucocele as the first manifestation of primary hyperparathyroidism

We describe the first case of brown tumor mimicking a maxillary sinus mucocele as the first manifestation of the patient's primary hyperparathyroidism. A 34-year old woman presented with a 14 days history of elevation of the right orbit, retrobulbar pain and cheek anesthesia. The CT and MR evaluation showed a mass, initially described as mucocele of the right maxillary sinus. The laboratory studies revealed hyperparathyroidism. The patient underwent acute surgery, and the mass appeared clinically as mucocele. The histological examination of the resected lesion revealed changes representing either giant cell granuloma or brown tumor. The finding of hyperparathyroidism confirmed the diagnosis of brown tumor. To our knowledge, this is the first report of cystic brown tumor mimicking a mucocele of the maxillary sinus.

A Case of Hyperparathyroidism Following Acute Pancreatitis

We report a case of 31-year-old man with acute pancreatitis associated with hypercalcemia as the first manifestation of primary hyperparathyroidism due to benign parathyroid adenoma. After initial, conservative treatment, intact PTH and serum calcium levels improved, which is followed by adenoma resection. Although parathyroid-adenoma-induced hypercalcemia is known to be associated with acute pancreatitis, the medical entity is very uncommon. The pathophysiology of hypercalcemia-induced acute pancreatitis is poorly understood despite proposed mechanisms. Because parathyroid adenoma with hypercalcemia is common, the relationship between hyperparathyroidism and pancreatitis or ossifying fibrosis requires better clarification.

Mandibular brown tumor as the first manifestation of primary hyperparathyroidism: A case report

Patients with primary hyperparathyroidism (brown tumor) are usually asymptomatic and clinical presentation of the tumor in the jaws is rarely the first sign of the disease. We report a 45-year-old female patient who presented with a mandibular swelling as the first sign of the disease.

Acute necrotizing pancreatitis as first manifestation of primary hyperparathyroidism

We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma. Initially the acute pancreatitis was treated conservatively. The patient subsequently underwent surgical resection of the parathyroid adenoma and surgical clearance of a large infected pancreatic pseudocyst. Although the association of parathyroid adenoma-induced hypercalcemia and acute pancreatitis is a known medical entity, it is very uncommon. The pathophysiology of hypercalcemia-induced acute pancreatitis is therefore not well known, although some mechanisms have been proposed. It is important to treat the provoking factor. Therefore, the cause of hypercalcemia should be identified early. Surgical resection of the parathyroid adenoma is the ultimate therapy.

Scintigraphic findings in hungry bone syndrome following parathyroidectomy

Prolonged hypocalcemia following parathyroidectomy, called hungry bone syndrome, is a common complication of parathyroid surgery seen in 13–30% of cases. In this article, we report the case of a 48-year-old woman with bone pain and multiple brown tumors as the first manifestation of primary hyperparathyroidism due to a large parathyroid adenoma. After parathyroidectomy, the patient presented clinical signs of hypocalcemia consistent with hungry bone syndrome. Scintigraphic and radiographic modifications following parathyroidectomy are described.

Pancreatitis as the first manifestation of multiple endocrine neoplasia type 2A

Multiple endocrine neoplasia type 2A (MEN2A) is an autosomal dominant inherited condition that predisposes to the triad of medullary thyroid cancer (MTC), pheochromocytoma (Pheo), and primary hyperparathyroidism (PHT). Nearly 100% of MEN2A are associated with germ line mutation of the RET proto-oncogene (RET), and DNA-based RET genotype analysis is now considered essential for earlier diagnosis. The first manifestation of MEN2A is most often due to MTC, and less frequently to Pheo. Rarely, MEN2A is recognized during the search for PHT associated conditions. Most patients with primary hyperparathyroidism are asymptomatic, and the focus of the presentation may be the side effects of chronic hypercalcemia, osteoporosis, renal lithiasis, peptic ulcer disease, and hypertension. Hypercalcemic pancreatitis is rare, being an uncommon first manifestation of PHT. Here, we report on a patient who presented recurrent pancreatitis as the first manifestation of MEN2A. In the present case, prompt sequential dosage of calcium, diagnosis of PHT, and genetic analysis would have resulted in pancreatitis prevention and early MEN2A management.

Parathyroid crisis as first manifestation of primary hyperparathyroidism

We report the case of a 61-year-old woman who suffered a parathyroid crisis due to a parathyroid adenoma. The patient presented with the typical clinical symptoms of hypercalcemia. Ca + 2 and PTH were markedly increased. Initially, she was treated conservatively until Ca + 2 returned to normal levels. Then, she underwent surgical excision of a newly diagnosed parathyroid adenoma. Parathyroid crisis (PC), also known as parathyroid storm or acute primary hyperparathyroidism, is a rare and serious complication of primary hyperparathyroidism (PH). Fewer than 200 cases have been described in the literature. Prognosis is poor: mortality is 100% in non-operable cases and 20% in cases in which parathyroidectomy is performed. We emphasize the importance of early diagnosis and aggressive treatment.

Abstract #202: Brown Tumor as the First Manifestation of Primary Hyperparathyroidism

Abstract #202: Brown Tumor as the First Manifestation of Primary Hyperparathyroidism