Endocrine Abstracts

Introduction: Primary hyperparathyroidism is an asymptomatic endocrine disorder in 80% of the cases. The bone manifestation represents the late stage of the disease and the brown tumor represents an exceptional and rare lesion.

Observation: We report the case of a 73-year-old patient, with a medical history of type 2 diabetes, followed in the oto-rhino-laryngology department for a gingival tumor. A biopsy was performed and the anatomopathological examination was in favor of a reparative granuloma. She was referred to our department for further exploration. The calcium phosphate balance showed an hypercalcemia at 3.37 mmol/l, an hypophosphatemia at 0.53 mmol/l and a high PTH at 451 pg/ml, suggesting primary hyperparathyroidism. The thyroid ultrasound showed no parathyroid nodules, with suspicious adenopathies and the parathyroid scintigraphy revealed a lower right parathyroid adenoma. Complementary thoraco-abdomino-pelvic CT scan revealed two retro-thyroid masses (left 34×16×53 mm and right 29×16 mm) with a lytic lesion type Ib Lodwick of the left iliac bone of 19 mm corresponding to a second brown tumor. As for the assessment of the complications of the hypercalcemia; the electrocardiogram showed a regular sinus rhythm at 60 bpm without shortening of the QT interval, the bone densitometry did not find osteoporosis and the renal ultrasound did not show any lithiasis. The patient was proposed for parathyroid surgery.

Discussion: Nowadays, it is rare that a brown tumor of the maxilla is the circumstance of discovery of hyperparathyroidism. But this lesion must always lead to a calcium level assessment, because the treatment is etiological and the tumors regress spontaneously after parathyroid surgery.