title: Brown tumors in dialyzed patients with secondary hyperparathyroidism: report of 16 cases.
abstract: Brown tumors (BTs) are relatively uncommon but they are serious complications of renal osteodystrophy. The objective of this study was to analyze the clinical, biological, and radiological characteristics of 16 patients with BTs provoked by secondary hyperparathyroidism (sHPT) and its response to the decrease in parathyroid hormone levels after parathyroidectomy (PTX). The management of that uncommon condition was also reviewed. We conducted a retrospective study including 16 end-stage renal disease patients who underwent subtotal PTX between 1997 and 2007 for severe sHPT with BTs. Our study included 10 men and 6 women, whose average age was 34 years. All patients were on dialysis. Ten of them were on dialysis for more than 5 years. The median duration on dialysis was 84 months. Patients included suffered from swellings associated with functional limitations. BTs had multiple locations in 7 patients. Jaw was the most frequent location (62%). Radiography and tomodensitometry demonstrated a mixed radio lucent and radio-opaque lesions with an expansion of the cortical bone. Bone scan demonstrated an increased uptake of lesions. Chirurgical treatment was indicated in all cases because of severe refractory sHPT with functional limitations and/or disfiguring deformities. In all cases, BTs stopped its progression and even decreased in size. However, it was insufficient in four cases, which required a surgical resection. PTX remains an efficacious approach in resistant cases of sHPT with persistent BTs.
authors.affiliation: Department of Nephrology, Fattouma Bourguiba Hospital, Monastir, Tunisia. mouuna121@yahoo.fr
authors.forename: Mouna
authors.initials: M
authors.lastname: Hamouda
authors.forename: Insaf
authors.initials: I
authors.lastname: Handous
authors.forename: Nasr
authors.initials: N
authors.lastname: Ben Dhia
authors.forename: Samia
authors.initials: S
authors.lastname: Ayachi
authors.forename: Ahmed
authors.initials: A
authors.lastname: Letaief
authors.forename: Sabra
authors.initials: S
authors.lastname: Aloui
authors.forename: Ammeur
authors.initials: A
authors.lastname: Frih
authors.forename: Habib
authors.initials: H
authors.lastname: Skhiri
authors.forename: Habib
authors.initials: H
authors.lastname: Khochtali
authors.forename: Mezri
authors.initials: M
authors.lastname: Elmay
mesh_terms: D000293:Adolescent; D000328:Adult; D001842:Bone and Bones / Q000473:pathology*; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000150:complications* / Q000628:therapy; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications* / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D055815:Young Adult