title: Contribution of 18-FDG PET/CT to brown tumor detection in a patient with primary hyperparathyroidism.
abstract: We report the case of a patient who presented with multiple brown tumors as the inaugural manifestation of primary hyperparathyroidism. Tc-99m hexakis methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy demonstrated increased radiotracer uptake by the bone lesions. The patient was a 65-year-old male who sought advice for a swelling on his right shin. An osteolytic lesion was visible on the radiograph. A bone biopsy showed a benign tumor containing abundant osteoclastic cells. Laboratory abnormalities included hypercalcemia (3.63mmol/L with 1.91mmol/L ionized calcium), hypophosphatemia (0.38mmol/L), and parathyroid hormone elevation (880.8pg/mL; N: 10-70). Serum 25-OH Vitamin D level was lower than 4ng/mL (N: 30-60). An 18-FDG PET/CT scan identified numerous high-uptake bone lesions. By 99mTc-MIBI scintigraphy, a large high-uptake mass was seen in the left parathyroid gland, as well as high-uptake lesions throughout the skeleton, which were less numerous than those seen by 18-FDG PET/CT. Ultrasonography of the neck visualized a mass consistent with an adenoma in the left parathyroid gland. Brown tumors are bone lesions whose diagnosis should be considered in patients with clinical and laboratory evidence of hyperparathyroidism, once a malignant disease is ruled out. Our case report suggests that 18-FDG PET/CT may be more sensitive than whole-body 99mTc-MIBI scintigraphy in detecting brown tumors.
authors.affiliation: Service de rhumatologie, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France. Electronic address: melanie.penhoat@chu-nantes.fr.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Gahier Penhoat
authors.affiliation: Service d'endocrinologie, CHU Nord, boulevard Professeur-Jacques-Monod, 44800 Saint-Herblain, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Drui
authors.affiliation: Service de médecine nucléaire, CHU Hôtel-Dieu, 44000 Nantes, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Ansquer
authors.affiliation: Service de chirurgie viscérale et endocrinienne, CHU Hôtel-Dieu, 44000 Nantes, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Mirallie
authors.affiliation: Service de rhumatologie, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Maugars
authors.affiliation: Service de rhumatologie, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Guillot
mesh_terms: D000236:Adenoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000368:Aged; D001706:Biopsy; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D001862:Bone Resorption / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D019788:Fluorodeoxyglucose F18; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D008297:Male; D010282:Parathyroid Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D017256:Technetium Tc 99m Sestamibi
keywords: 18-FDG PET/CT; Brown tumor; Hypercalcemia; Hyperparathyroidism; Tc-99m MIBI scintigraphy