Osteitis fibrosa cystica as a clinical manifestation of secondary hyperparathyroidism

Abstract

Introduction: Brown tumors are a localized form of osteitis fibrosa cystica, which is a non neoplastic complication of hyperparathyroidism (HPT), hystologically characterized for the substitution of osteocytes by fibrous tissue. These lesions can appear anywhere along the bone skeleton, more frequently in long bones, and less frequently in ribs, pelvis and facial bones. However, most patients with these kind of lesions in unusual localizations, are initially wrongly diagnosed and their chances of getting an early treatment are diminished.

Purpose: Contribute to awareness of this manifestation to accomplish the right identification, diagnosis, and early approach of these patients, diminishing the risk of developing complications.

Case presentation: 22 year old patient, with chronic kidney disease (CKD), who consult with refractory hyperparathyroidism, with an expansive palatal lesion, configuring an unusually localized osteitis fibrosa, surgically intervened with subtotal parathyroidectomy, which was insufficient for patient’s hyperparathyroidism and its established complications.

Discussion: In patients with CKD, synthesis of calcitirol and calcium’s reabsorption are affected as a consequence to the loss of functional kidney tissue. In order to keep the regulation of serum levels of calcium and phosphorus, parathyroid’s activity is increased and so is the synthesis of parathyroid hormone, which stimulates bone resorption. Once bone resorption becomes persistent, it leads to the development of osteitis fibrosa cystica, one of the manifestations of Bone Mineral Disease, a systemic complication of hyperparathyroidism.

Conclusion: Brown tumors are a consequence of advanced HPT, which is why medical staff should be educated in the course of HPT in patients with CKD, and develop skills to recognize its complications in order to favor early diagnosis and treatment.