Esselmani Hicham, Aimrane Abdelmohcine, Chatoui Hicham, El Hiba Omar, Najimi Mustapha, Merzouki Mohamed
Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal 23000, Morocco.
Anthropogenetics, Biotechnologies and Health Laboratory, Nutritional Physiopathologies, Neurosciences and Toxicology Team, Faculty of Sciences, Chouaib Doukkali University, El Jadida 24000, Morocco.
Neurol Int. 2025 Jan 30;17(2):22. doi: 10.3390/neurolint17020022.
BACKGROUND/OBJECTIVES: Brown tumors are rare bone lesions associated with hyperparathyroidism, particularly secondary hyperparathyroidism (SHPT), in chronic renal failure. While brown tumors commonly affect bones rich in marrow, the involvement of the sphenoid sinus is extremely rare and can present with neurological symptoms. This study reports a case of a sphenoid sinus brown tumor in a patient on hemodialysis, highlighting its clinical presentation and diagnostic challenges.
A 31-year-old woman undergoing chronic hemodialysis presented with a severe headache, diplopia, and progressive vision loss in her left eye. Laboratory tests revealed hypercalcemia, hypophosphatemia, and elevated parathyroid hormone (PTH) levels, consistent with SHPT. The diagnosis was confirmed through a clinical examination and magnetic resonance imaging (MRI).
The clinical examination confirmed decreased visual acuity in the left eye. The laboratory results revealed serum calcium of 15.5 mg/dL, phosphate of 1.0 mg/dL, and PTH of 2000 pg/mL, consistent with SHPT. The imaging studies identified a brown tumor in the sphenoid sinus exerting a mass effect on adjacent structures. This case underscores the rarity of brown tumors in this location, with very few similar reports in the literature.
Although rare, brown tumors should be considered in patients with SHPT who present with neurological symptoms or cranial lesions. An early diagnosis through biochemical and imaging studies is crucial to prevent severe complications. The management involves treating the underlying hyperparathyroidism, with surgical intervention indicated in cases of neural compression.
背景/目的：棕色瘤是一种罕见的骨病变，与慢性肾衰竭中的甲状旁腺功能亢进，尤其是继发性甲状旁腺功能亢进（SHPT）相关。虽然棕色瘤通常影响富含骨髓的骨骼，但蝶窦受累极为罕见，且可出现神经症状。本研究报告了一例血液透析患者的蝶窦棕色瘤病例，突出了其临床表现和诊断挑战。
一名31岁接受慢性血液透析的女性出现严重头痛、复视和左眼渐进性视力丧失。实验室检查显示高钙血症、低磷血症和甲状旁腺激素（PTH）水平升高，符合SHPT。通过临床检查和磁共振成像（MRI）确诊。
临床检查证实左眼视力下降。实验室结果显示血清钙为15.5mg/dL，磷为1.0mg/dL，PTH为2000pg/mL，符合SHPT。影像学研究发现蝶窦有一个棕色瘤，对相邻结构产生占位效应。该病例强调了该部位棕色瘤的罕见性，文献中类似报道极少。
尽管罕见，但对于出现神经症状或颅骨病变的SHPT患者应考虑棕色瘤。通过生化和影像学研究进行早期诊断对于预防严重并发症至关重要。治疗包括治疗潜在的甲状旁腺功能亢进，在神经受压的情况下需进行手术干预。
