Brown jaw tumors: today's unusual presentation of primary hyperparathyroidism.
Primary hyperparathyroidism (pHPT) has changed its clinical features in the last decade becoming a mild biochemical disease, in which the classical fibrous cystic osteitis is a rare complication. The more frequent bone involvement in primary hyperparathyroidism is observed at the distal 1/3 of the radius, where the cortical bone is primarily represented. However, lumbar and femoral osteopenia or osteoporosis prevalently affect hyperparathyroid post-menopausal women. We report two, otherwise healthy, young male patients, who presented a painful jaw swelling. In both patients standard radiographic imaging revealed a low-density well-defined lesion, which caused jaw bone destruction. High levels of serum calcium (14.1-16.6 mg/dl, n.v. 8.1-10.4) and PTH (1172-1928 pg/ml, n.v. 10-65) indicated the presence of pHPT associated with hypertension, asymptomatic renal involvement and osteoporosis with normal serum 25-hydroxyvitamin D levels in both patients. A single huge parathyroid adenoma was successfully removed and within 2 months jaw lesions were almost completely re-mineralized without any other therapeutic intervention in both patients. In conclusion, although brown jaw tumors are a rare complication of the hyperparathyroidism, they should be considered and identified in young patients with severe pHPT. Moreover, such a complication seems to be independent from vitamin D deficiency, suggesting the involvement of other pathogenetic factors.
Institute of Endocrine Sciences, University of Milan, Ospedale Maggiore IRCCS, Milano, Italy.
S
S
Corbetta
D
D
Rossi
O
O
D'Orto
L
L
Vicentini
P
P
Beck-Peccoz
A
A
Spada
D000328:Adult; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology*; D007573:Jaw Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D010024:Osteoporosis / Q000209:etiology; D010282:Parathyroid Neoplasms / Q000150:complications* / Q000601:surgery; D016105:Parathyroidectomy; D011859:Radiography