Brown tumours (osteitis fibrosa cystica) are the classic bone disease of hyperparathyroidism. Parathyroid carcinoma is an uncommon cause of PTH dependent hypercalcaemia. We present the case of a 63-year-old man who presented to the ENT department with persistent right-sided nasal obstruction and nasal swelling. He was otherwise asymptomatic. He had a long history of nasal polyps, which had recently been resected. Browns tumour of the maxilla was demonstrated on nasal biopsy. Subsequent investigations revealed an elevated calcium of 3.64 mmol/l (Normal range 2.122.55 mmol/l) and a grossly elevated parathyroid hormone (PTH) of 827 ng/l (Normal range 1565 ng/l). Referral was made to the endocrine department. Ultrasound scan of the neck revealed a 3.1×2.6×3.0 cm mass, with cystic and solid components, in the left lower pole of the thyroid. There was intense uptake of Sestamibi in left lower pole of the thyroid and to the right of the midline in the face. Parathyroidectomy, left lobectomy and central node dissection was performed surgically. Histology demonstrated parathyroid carcinoma with clear resection margins. The patient remains well at follow-up after one year. Sestamibi uptake in the region of the right maxilla was less than previously with none within the neck or elsewhere in the body. His PTH however remains elevated.
First described by von Recklinghausen in 1891 Browns tumours are more often found in trabecular portions of the jaw, long bones and the rib. Browns tumours of the facial bones have only rarely been described. Classic bone manifestations associated with hyperparathyroidism such as osteitis fibrosa cystica, subperiosteal bone resorption, salt and pepper skull and absent lamina dura are more commonly seen in parathyroid carcinoma (4491%) than primary hyperparathyroidism (<5%). High serum calcium levels, high levels of parathyroid hormone, nephrocalcinosis, pancreatitis, peptic ulcer disease and anaemia should also raise the suspicion of parathyroid carcinoma.
01 - 05 Apr 2006
European Society of Endocrinology