title: An unusual presentation of primary hyperparathyroidism: multiple brown tumors and coexisting thyroid carcinoma.
abstract: We present a patient with a complex clinical picture of primary hyperparathyroidism with multiple destructive skeletal lesions suspicious of bone metastases and concomitant multifocal papillary thyroid carcinoma with a metastatic central lymph node. He presented with progressively worsening right hip pain and restricted motion. Magnetic resonance imaging revealed multiple lytic lesions involving predominantly the right trochanter minor and the left inferior and posterior pubic rami. Biochemical tests were consistent with primary hyperparathyroidism. Neck ultrasound and parathyroid scintigraphy revealed a single parathyroid adenoma and a thyroid nodule, preoperative cytology of which confirmed papillary thyroid carcinoma, as did the final surgical specimen. Biochemical results, regarding hyperparathyroidism, declined to normal levels and his complaints gradually decreased after surgery. Postoperative whole body bone scintigraphy showed increased tracer uptakes at multiple sites, but they were proved to be metabolically inactive by fluorodeoxyglucose positron emission tomography/computed tomography.
authors.affiliation: Gulhane Military Medical Academy and School of Medicine, Department of Endocrinology and Metabolism, Etlik, Ankara, Turkey.
authors.forename: Y
authors.initials: Y
authors.lastname: Basaran
authors.affiliation: Gulhane Military Medical Academy and School of Medicine, Department of Nuclear Medicine, Etlik, Ankara, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Ince
authors.affiliation: Gulhane Military Medical Academy and School of Medicine, Department of Nuclear Medicine, Etlik, Ankara, Turkey. Electronic address: ealagoz@gata.edu.tr.
authors.forename: E
authors.initials: E
authors.lastname: Alagoz
authors.affiliation: Gulhane Military Medical Academy and School of Medicine, Department of Endocrinology and Metabolism, Etlik, Ankara, Turkey.
authors.forename: C
authors.initials: C
authors.lastname: Meric
authors.affiliation: Gulhane Military Medical Academy and School of Medicine, Department of Endocrinology and Metabolism, Etlik, Ankara, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Taslipinar
mesh_terms: D000328:Adult; D002291:Carcinoma, Papillary / Q000150:complications*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications* / Q000473:pathology*; D008297:Male; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000150:complications*
keywords: Adenoma paratiroideo; Bone scintigraphy; Brown tumor; FDG PET/CT; FDG PET/TC; Gammagrafía ósea; Parathyroid adenoma; Tumor pardo