title: Multilevel brown tumors of the spine in a patient with severe secondary hyperparathyroidism A case report and review of the literature.
abstract: BACKGROUND
  The brown tumour is an extreme form of osteitis fibrosa cystica, representing a serious complication of the advanced primary or secondary hyperparathyroidism. It occurs in settings of high levels parathyroid hormone, like in primary or secondary hyperparathyroidism, with a frequency of 3-4% and 1.5-13% respectively, usually affecting young people.
  
  
  METHODS
  The authors report a case of a 45 years old woman on long-term hemodialysis, with severe secondary hyperparathyroidism. The main clinical complaints were neck pain, lower thoraco-lumbar back pain, persistent left groin pain, and bilateral lower extremities weakness. The computed tomography scan revealed multiple spine brown tumors affecting the cervical, thoracic and lumbar level. After an initial partial response to the treatment of two years with Cinacalcet, a deterioration of the secondary hyperparathyroidism occurred (hypercalcemia, hyperphosphatemia) and the patient was referred for parathyroidectomy. The patient underwent total parathyroidectomy with auto-transplantation, with a positive postoperative result.
  
  
  CONCLUSIONS
  Secondary hyperparathyroidism can lead, during its course, to osteolytic bone lesions called brown tumors. If the medical treatment fails, the surgical removal of the parathyroid glands with autotransplant remains the only treatment of the bone lesions progression. Reviewing the relevant literature in English (until March 2015), we found 24 cases of symptomatic vertebral brown tumors. To the authors' knowledge, this is the first case which describes a multilevel spine involvement (more than two), and the fifth describing a cervical localization.
  
  
  BACKGROUND
  Hypocalcaemia, Secondary hyperparathyroidism, Spine brown tumors.
authors.forename: Daniela
authors.initials: D
authors.lastname: Salamone
authors.forename: Simona
authors.initials: S
authors.lastname: Muresan
authors.forename: Mircea
authors.initials: M
authors.lastname: Muresan
authors.forename: Radu
authors.initials: R
authors.lastname: Neagoe
mesh_terms: D015415:Biomarkers / Q000097:blood; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000628:therapy; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010002:Osteitis Fibrosa Cystica / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000379:methods; D006435:Renal Dialysis / Q000009:adverse effects; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone