Craniofacial Brown Tumor Secondary to Persistent Multiglandular Primary Hyperparathyroidism: A Reversible Complication
https://doi.org/10.15605/jafes.041.S1
- Author:
Fathiyah Ramly
1
;
Siti Sanaa Wan Azman
1
;
Masliza Hanuni Mohd Ali
1
;
Wan Mohd Hafez Wan Hamzah
1
Author Information
1. Endocrinology Unit, Department of Internal Medicine, Hospital Sultanah Nur Zahirah
- Publication Type:Journal Article
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):76-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Brown tumors, also known as osteitis fibrosa cystica, are
focal bone lesions resulting from increased osteoclastic
activity and fibroblastic proliferation. They represent a
rare complication of uncontrolled hyperparathyroidism
(HPT) and may affect any part of the skeleton, including
craniofacial bones.
Case:We report a case of a 31-year-old Malay female diagnosed
with primary HPT secondary to multiglandular disease,
who initially presented with symptomatic hypercalcemia.
Biochemical evaluation revealed elevated corrected calcium
(2.84 mmol/L; reference range 2.2–2.6 mmol/L), low
phosphate (0.63 mmol/L; reference range 0.8–1.6 mmol/L),
and markedly elevated serum intact parathyroid hormone
(iPTH) (286 pg/mL; reference range 14.9–56.9 pg/mL).
Ultrasound parathyroid showed a large right extrathyroidal
lesion, most likely suggestive of parathyroid adenoma,
where sestamibi scan suggested multiglandular parathyroid adenomas with possible mediastinal involvement. She
underwent exploratory parathyroidectomy on 19 June 2024,
with excision of bilateral inferior parathyroid adenomas
confirmed on histopathology. Despite surgery, she had
persistent hypercalcemia (2.8–3.1 mmol/L) and rising iPTH
levels (307 pg/mL on 24 June 2024, increasing to 413 pg/mL by
2 September 2024), consistent with persistent disease. Repeat
imaging demonstrated hyperfunctioning parathyroid tissue
in the anterior mediastinum. Subsequently, the patient
developed progressive enlargement of the left upper gingiva
associated with significant pain during mastication. Clinical
and radiological evaluation revealed aggressive lesions
with cortical expansion. Excisional biopsy of the gingival
lesion confirmed the diagnosis of brown tumors involving
the jaws. She later underwent a second parathyroidectomy
with intraoperative parathyroid hormone monitoring at
another centre. Postoperatively, normalization of serum
calcium and iPTH levels was achieved, which led to marked
clinical improvement and regression of the craniofacial
brown tumor.
Conclusion:This case highlights that skeletal manifestations of HPT,
including brown tumors, may regress following adequate
biochemical control without additional local therapy. Early
recognition and definitive surgical management of persistent or ectopic hyperfunctioning parathyroid tissue are
essential to prevent progression and promote spontaneous
bone healing processes.
- Full text:2026080411143238544EP_A103.pdf
