Giant cell granuloma is a skeletal manifestation seen now rarely in hyperparathyroidism due to early recognition of the disease. Lesions usually occur in the areas of intense bone resorption. They can affect mandible, maxilla, clavicle, ribs and pelvic bones. Most of the patients who have primary hyperparathyroidism are asymptomatic and are discovered incidentally during laboratory examinations. Here, we represent a female patient who was referred to endocrinology clinics because of maxillary brown tumor detected by her dentist.
Case: Thirty-years-old female patient has admitted to dental clinics with the complaint of oral mass and accompanying symptoms as decreased apetite, weight loss and numbness on the jaw. Biopsy of the oral lesion was consistent with giant cell granuloma. Radiographic imaging has revealed multiple bone cysts on the mandible and maxillary bones. In laboratory exam, severe hypercalcemia and hypophosphatemia were detected. Her serum parathormon level and urinary calcium level were elevated. In ultrasonographic examination, we have detected two parathyroid adenomas on left side and MIBI scan was positive. In bone mineral densitometry, osteoporosis was detected at the lumbar vertebrates. She didnt have any renal stones in abdominal ultrasonography. We have searched for MEN1 syndrome. There was a microadenoma in pituitary MRI that was proven nonfunctional with hormone tests. Her upper gastro intestinal endoscopy was normal as the serum gastrin levels. She underwent surgery and all parathyroid glands and thymus were excised then 1/2 of a parathyroid gland was seeded on forearm. No complications occurred during or after surgery and she was discharged and referred to her dentist for curettage of the bone cysts.
Treatment of parathyroidism is surgery. However, treatment for bone lesions is controversial. They can regress after removal of the adenoma. In the persistent cases, surgical removal of the bone lesion after a short course of steroid therapy is advised.
27 Apr - 01 May 2013
European Society of Endocrinology