Kormanis Aryn, Anderson Matthew, McKnight Miya, Darapu Hima
Department of Endocrinology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA.
JCEM Case Rep. 2025 Mar 20;3(4):luaf022. doi: 10.1210/jcemcr/luaf022. eCollection 2025 Apr.
A 26-year-old male with medical history of polycystic kidney disease, IgA nephropathy, end-stage renal disease, and brown tumor (requiring prior surgical intervention on brown tumor) was hospitalized because of right lower extremity weakness. Examination revealed right hip flexor weakness and right foot clonus. Laboratory results showed serum calcium of 10.4 mg/dL (2.59 mmol/L) (reference range: 8.5-10.5 mg/dL; 2.12-2.62 mmol/L). Magnetic resonance imaging displayed a 2.5 × 3.7 cm soft tissue mass with circumferential encroachment of the epidural space leading to severe spinal canal stenosis of T4-T5 at the site of prior brown tumor resection. The patient underwent subtotal parathyroidectomy with left cervical thymectomy, leading to an intraoperative PTH drop from >3500 pg/mL (>371 pmol/L) (reference range: 12-88 pg/mL; 1.27-9.33 pmol/L) to 247 pg/mL (26.182 pmol/L). In the context of treating vertebral brown tumors, the consensus suggests that parathyroidectomy plays a crucial role in achieving both clinical and radiographical amelioration of the tumor. However, in cases like ours where paresis is present, surgical decompression of the tumor becomes imperative. The development of brown tumors is an uncommon and severe, long-term complication for hyperparathyroidism. The location of a brown tumor in the thoracic spine causing symptomatic cord compression is rare.
一名26岁男性，有多囊肾病、IgA肾病、终末期肾病病史，曾因棕色瘤接受过手术干预（棕色瘤切除术），因右下肢无力入院。检查发现右髋屈肌无力及右足阵挛。实验室检查结果显示血清钙为10.4 mg/dL（2.59 mmol/L）（参考范围：8.5 - 10.5 mg/dL；2.12 - 2.62 mmol/L）。磁共振成像显示在先前棕色瘤切除部位有一个2.5 × 3.7 cm的软组织肿块，其环绕侵犯硬膜外间隙，导致T4 - T5节段严重椎管狭窄。患者接受了甲状旁腺次全切除术及左颈胸腺切除术，术中甲状旁腺激素（PTH）从>3500 pg/mL（>371 pmol/L）（参考范围：12 - 88 pg/mL；1.27 - 9.33 pmol/L）降至247 pg/mL（26.182 pmol/L）。在治疗椎体棕色瘤方面，共识认为甲状旁腺切除术对于实现肿瘤的临床和影像学改善起着关键作用。然而，在像我们这样存在轻瘫的病例中，对肿瘤进行手术减压变得势在必行。棕色瘤的发生是甲状旁腺功能亢进一种罕见且严重的长期并发症。棕色瘤位于胸椎导致有症状的脊髓受压的情况很罕见。
