Endocrine Abstracts

Introduction: Brown tumor or osteitis fibrocystica is a benign bone lesion reflecting an abnormality of bone metabolism in the context of hyperparathyroidism. It can affect the entire skeleton, including the pelvis, ribs, clavicles and extremities. Involvement of the maxillary bone is very uncommon. We present a case of multiple brown tumors with an unusual maxillo-mandibular localization, revealed by a disorder of phosphocalcic metabolism and tertiary hyperparathyroidism. This case reminds us of the difficulty to establish a correct diagnosis in patients with an osteolytic process of the maxilla and the necessity to look for hyperparathyroidism in front of a giant cell lesion given the insidious character of this endocrinopathy.

Observation: 32 year old female patient with the following history – Chronic kidney disease at dialysis stage – HTA under ARB II – Viral hepatitis C– Left femoral per trochanteric fractureHistory of the DiseaseThe history of the disease began 2 years ago with the appearance of a maxillo-mandibular bone tumor that had been surgically resected with a brown giant cell tumor at the anapath, and whose etiological exploration revealed hyperparathyroidism:• PTH 668 pg/ml (11×N) and normocalcemia 99 mg/l• Localization test : a right parathyroid nodule of 17 mm on CT scanThe patient was operated, the procedure consisted in a para thyroidectomy with simple postoperative course and the result of the anapathy was a parathyroid hyperplasia. Nevertheless, the evolution was marked by the recurrence of her maxillomandibular tumor, which progressively increased in volume, reaching facial deformation and oral obstruction, making feeding difficult. With a probable tertiary hyperparathyroidism• PTH more than 20×N and normocalcemia at 98 mg/l• MIBI scintigraphy with pathological parathyroid of the posterior inferior face of the left lobe of the thyroid. The patient was referred to our training for further treatment. Functionally she shows a deep asthenia. Clinical ExaminationVoluminous mass of the facial mass, painless on palpation, obstructing the oral cavity and causing a tooth separation and intermittent gingivorrhagia. Painless right tibial bone swelling on palpation causing no functional impotence. We are faced with a biologically confirmed hyperparathyroidism initially secondary to kidney failure which has become autonomous with the appearance of a parathyroid nodule marking the transition to tertiary hyperparathyroidism.

Conclusion: The diagnosis of hyperparathyroidism avoids the need of surgery for brown maxillary tumors that should regress after removal of the parathyroid lesion.