Endocrine Abstracts

JOINT833

Introduction: Brown tumour or fibrocystic osteitis is a rare benign bone lesion secondary to hyperparathyroidism. It can affect the entire bony skeleton, including the pelvis, ribs, clavicles and limbs. However some infrequent localisations are possible such as cranial and facial bone damage. we present a case of a sphenoidal brown tumour associated with tertiary hyperparathyroidism.

Case presentation: The patient was 33 years old and had been on haemodialysis for more than 8 years for chronic renal failure in a single polycystic kidney complicated by tertiary hyperparathyroidism with major hyperparathormonemia at 1398 ng/ml. The patient presented with a pituitary tumour syndrome consisting of headaches with decreased visual acuity, especially on the left side, associated with a galactorrhoea amenorrhoea syndrome that had been evolving for 1 year. Cerebral MRI revealed a 51*35*33 mm process involving the base of the skull, displacing the pituitary gland and centred on the sphenoid bone, initially suggesting a brown tumour, which was confirmed by CT scan with the presence of calcifications and a clear blowing aspect of the sphenoid cortex. Hormonally, she was complicated by anteropituitary insufficiency, which we substituted, in particular corticotropic, thyrotropic and gonadotropic insufficiency, associated with hyperprolactinaemia of probable disconnection. Finally, the patient was scheduled for neurosurgery in view of her visual prognosis.

Discussion: First described in 1891, the brown tumour is a fibrocystic bone lesion caused by hyperactivity of osteoclasts, as a result of hyperparathyroidism. It is an uncommon complication that can affect the entire bony skeleton, including pelvis, ribs, clavicles and extremities. Involvement of the sphenoidal bone is considered rare, hence the particularity of our case. The brown tumours may be completely asymptomatic or manifest as bone pain or pathological fractures, which was the case of our patient, mimicking a pituitary adenoma.

Bibliography: 1. H. Guerrouj, I. Ghfir, O. Ait Sahel, N. Benrais: Tertiary hyperparathyroidism with multifocal brown tumors: A case report. Médecine Nucléaire, Volume 41, Issue 2, March–April 2017, Pages 131-135. 2. Fassih, L. Taali, M. Akssim, R. Abada, S. Rouadi, M. Mahtar, M. Roubal, M. Essaadi, M. Fatmi El Kadiri: Tumeur brune du maxillaire révélatrice d'hyperparathyroidie primaire: à propos d'un cas et revue de la littérature. Pan Afr Med J. 2013 Jan 15;14:21. [Article in French] doi: 10.11604/pamj.2013.14.21.1359