Ghernautan Victoria, Idrees Zarwa, Nassar Mahmoud, Ciobanu Camelia, Ramdass Adesh
Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals Queens, New York, USA.
Medicine, St. Barnabas Hospital, The Bronx, USA.
Cureus. 2021 Aug 8;13(8):e17000. doi: 10.7759/cureus.17000. eCollection 2021 Aug.
Brown tumor of the bone or osteitis fibrosa cystica is a rare manifestation of hyperparathyroidism, most seen nowadays in association with secondary and tertiary hyperparathyroidism. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are the major culprits of secondary hyperparathyroidism (sHPTH). CKD is known to cause phosphate retention and a decrease in 1,25-dihydroxyvitamin D and ionized calcium levels, which in turn trigger the PTH secretion. Brown tumor can affect the jawbones, femur, sternum, ribs, and rarely the spine. We present the case of a 60-year-old male with ESRD on hemodialysis who was found to have lytic bone lesions in the thoracic and lumbar spine. Initially, malignancy was suspected. Blood work revealed markedly elevated PTH at 3,563 pg/mL, hypocalcemia, and hyperphosphatemia. Biopsy of the L5-S1 lesion was consistent with reactive changes due to sHPTH. Once a diagnosis of the brown tumor was confirmed, the patient was started on cinacalcet and was referred for parathyroidectomy.
骨棕色瘤或纤维囊性骨炎是甲状旁腺功能亢进的一种罕见表现，如今多见于继发性和三发性甲状旁腺功能亢进。慢性肾脏病（CKD）和终末期肾病（ESRD）是继发性甲状旁腺功能亢进（sHPTH）的主要病因。已知CKD会导致磷酸盐潴留以及1,25 - 二羟维生素D和离子钙水平降低，进而触发甲状旁腺激素（PTH）分泌。棕色瘤可累及颌骨、股骨、胸骨、肋骨，很少累及脊柱。我们报告一例60岁接受血液透析的ESRD男性患者，其胸腰椎发现溶骨性骨病变。最初怀疑为恶性肿瘤。血液检查显示PTH显著升高至3563 pg/mL，伴有低钙血症和高磷血症。L5 - S1病变的活检结果与sHPTH引起的反应性改变一致。一旦确诊为棕色瘤，患者开始服用西那卡塞，并被转诊接受甲状旁腺切除术。
