Journal of the Chinese Medical Association
Volume 73, Issue 3 , Pages 177-180, March 2010

Primary Hyperparathyroidism With Brown Tumor Mimicking Metastatic Bone Malignancy

  • Alvin W. Su

      Affiliations

    • Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Cheng-Fong Chen

      Affiliations

    • Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Ching-Kuei Huang

      Affiliations

    • Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Paul Chih-Hsueh Chen

      Affiliations

    • Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Wei-Ming Chen

      Affiliations

    • Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Wei-Ming Chen, Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.
    • ,
  • Tain-Hsiung Chen

      Affiliations

    • Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.

Received 14 May 2009; accepted 14 January 2010.

Article Outline

Bone and joint pain are commonly encountered conditions in daily practice. In the elderly, when osteolytic lesions are identified in imaging studies, metastatic bone tumor is the first impression that comes to the clinician's mind. Although the worst-case scenario should be ruled in, other differential diagnoses such as metabolic bone disease should be considered as well. We report a case of brown tumor caused by parathyroid adenoma. The patient had initial presentation of diffuse bone pain and multiple osteolytic lesions on imaging studies similar to metastatic bone tumor. With a systematic approach and awareness of metabolic bone disease, an accurate diagnosis was finally reached. Appropriate treatments, including preventive internal fixation of the impending femoral fracture and surgical excision of the parathyroid adenoma were performed accordingly. The key treatment for the condition was surgical excision of the parathyroid adenoma. After normalization of serum intact-parathyroid hormone level, the bony lesions resolved and required no further orthopedic surgery. The patient is now symptom-free. In addition to suspecting malignancy, the clinician should be highly alert to other possible causes of bony lesions. Brown tumor should be kept in mind during daily practice.

Key Words:  bone neoplasm , brown tumor , hypercalcemia , metabolic bone disease , parathyroid adenoma

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References 

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PII: S1726-4901(10)70035-6

doi:10.1016/S1726-4901(10)70035-6

Journal of the Chinese Medical Association
Volume 73, Issue 3 , Pages 177-180, March 2010

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