title: A brown tumor after biliopancreatic diversion for severe obesity.
abstract: A case of a brown tumor due to iatrogenic malabsorption following biliopancreatic diversion (BPD) is presented. A 52 year old women with a history of BPD 2 years before was referred to orthopedic surgery because of a painful lytic lesion of the left ankle. A bone biopsy revealed a giant cell tumor compatible with the diagnosis of a brown tumor. Subsequent metabolic evaluation showed severe 25-hydroxy vitamin D deficiency and secondary hyperparathyroidism (PTH 60 ng/L or twice the upper normal limit). Bone mineral density was decreased at the femoral neck (0.50 g/cm(2) ; T score of -3.92 or 66% of the expected value) and lumbar spine (T score of -1.75 or 93% of the expected value). A brown tumor can be the presenting symptom of iatrogenic malabsorption due to BPD. This case illustrates the severity of potential bone complications after BPD and the necessity of lifelong surveillance and vitamin supplements after BPD.
authors.affiliation: Department of Endocrinology, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Katrien
authors.initials: K
authors.lastname: Benhalima
authors.forename: Benhalima
authors.initials: B
authors.lastname: Katrien
authors.forename: Ann
authors.initials: A
authors.lastname: Mertens
authors.forename: Mertens
authors.initials: M
authors.lastname: Ann
authors.forename: Annick
authors.initials: A
authors.lastname: Van den Bruel
authors.forename: Van den Bruel
authors.initials: Vd
authors.lastname: Annick
authors.forename: Katrien
authors.initials: K
authors.lastname: Laga
authors.forename: Laga
authors.initials: L
authors.lastname: Katrien
authors.forename: Dirk
authors.initials: D
authors.lastname: Vanderschueren
authors.forename: Vanderschueren
authors.initials: V
authors.lastname: Dirk
authors.forename: Ignace
authors.initials: I
authors.lastname: Samson
authors.forename: Samson
authors.initials: S
authors.lastname: Ignace
authors.forename: Boudewijin
authors.initials: B
authors.lastname: Van Damme
authors.forename: Van Damme
authors.initials: VD
authors.lastname: Boudewijin
authors.forename: Roger
authors.initials: R
authors.lastname: Bouillon
authors.forename: Bouillon
authors.initials: B
authors.lastname: Roger
mesh_terms: D019386:Alendronate / Q000627:therapeutic use; D015904:Biliopancreatic Diversion / Q000009:adverse effects*; D015519:Bone Density; D002112:Calcifediol / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology*; D007049:Iatrogenic Disease; D008286:Malabsorption Syndromes / Q000209:etiology*; D008875:Middle Aged; D010002:Osteitis Fibrosa Cystica / Q000209:etiology* / Q000473:pathology; D014808:Vitamin D Deficiency / Q000188:drug therapy / Q000209:etiology*
chemical_list: D002112:Calcifediol; D002118:Calcium; D019386:Alendronate