title: Supra-acetabular brown tumor due to primary hyperparathyroidism associated with chronic renal failure.
abstract: A 63-year-old woman presented to the Orthopedic Unit of our hospital complaining of right hip pain of 6 months' duration associated with a worsening limp. Her past medical history included chronic renal insufficiency. Physical examination revealed deep pain in the iliac region and severe restriction of the right hip's articular function in the maximum degrees of range of motion. X-rays and CT scan detected an osteolytic and expansive lesion of the right supra-acetabular region with structural reabsorption of the right iliac wing. 99mTc-MDP whole-body bone scan showed an abnormal uptake in the right iliac region. Bone biopsy revealed an osteolytic lesion with multinucleated giant cells, indicating a brown tumor. Serum intact PTH was elevated (1020 pg/ml; normal values, 12-62 pg/ml), but her serum calcium was normal (total=9.4 mg/dl, nv 8.5-10.5; ionized=5.0 mg/dl, nv 4.2-5.4) due to the coexistence of chronic renal failure. 99mTc-MIBI scintigraphy revealed a single focus of sestamibi accumulation in the left retrosternal location, which turned out to be an intrathoracic parathyroid adenoma at surgical exploration. After surgical removal of the parathyroid adenoma, PTH levels decreased to 212 pg/ml. Three months after parathyroidectomy, the imaging studies showed complete recovery of the osteolytic lesion, thus avoiding any orthopedic surgery. This case is noteworthy because (1) primary hyperparathyroidism was not suspected due to the normocalcemia, likely attributable to the coexistence of chronic renal failure; and (2) it was associated with a brown tumor of unusual location (right supra-acetabular region).
authors.affiliation: Department of Clinical Experimental Medicine and Pharmacology, University of Messina, Messina, Italy. rmruggeri@unime.it
authors.forename: Rosaria M
authors.initials: RM
authors.lastname: Ruggeri
authors.forename: Emanuele
authors.initials: E
authors.lastname: Calamoneri
authors.forename: Antonia
authors.initials: A
authors.lastname: Russo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sindoni
authors.forename: Baldassarre
authors.initials: B
authors.lastname: Mondello
authors.forename: Maurizio
authors.initials: M
authors.lastname: Monaco
authors.forename: Michele A
authors.initials: MA
authors.lastname: Rosa
authors.forename: Sergio
authors.initials: S
authors.lastname: Baldari
authors.forename: Salvatore
authors.initials: S
authors.lastname: Benvenga
authors.forename: Alfredo
authors.initials: A
authors.lastname: Campennì
authors.forename: Francesco
authors.initials: F
authors.lastname: Trimarchi
mesh_terms: D001859:Bone Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008875:Middle Aged; D011877:Radionuclide Imaging