Gohar Ali, Ahmad Muhammad Husnain, Masroor Momina, Ali Masab, Ayman Ayesha, Usman Ali, Riaz Zainab, Ahmed Bilal
Department of Internal Medicine, Lahore General Hospital, Lahore, Punjab, Pakistan.
Department of Medicine, Tentishev Satkynbai Memorial Asian Medical Institute, Kant, Kyrgyzstan.
Medicine (Baltimore). 2025 Sep 5;104(36):e44342. doi: 10.1097/MD.0000000000044342.
Brown tumor (osteitis fibrosa cystica) is a benign bone lesion associated with hyperparathyroidism that can affect multiple bones in patients with end-stage renal disease (ESRD).
We present the case of a 32-year-old female with ESRD on maintenance hemodialysis who experienced body aches, muscle weakness, constipation, and mood swings for 3 months.
Initial tests revealed elevated parathyroid hormone (PTH), serum calcium, and phosphorus levels. A technetium-99m sestamibi scan identified a parathyroid adenoma in the inferior pole of the left thyroid lobe.
Despite conservative management, she underwent parathyroidectomy 2 years later, with biopsy showing parathyroid hyperplasia. Postoperatively, her symptoms persisted, and labs indicated elevated PTH, low serum calcium, and normal phosphorus. A repeat sestamibi scan detected a new adenoma in the right thyroid lobe and a brown tumor in the mandible. X-ray showed a left humerus fracture, and a bone scan revealed increased uptake in the skull, mandible, and multiple joints.
The presence of a parathyroid adenoma, elevated PTH levels, chronic kidney disease requiring dialysis, and specific imaging findings suggest a potential diagnosis of brown tumor of the bone. This case illustrates the complexity of managing hyperparathyroidism in ESRD, particularly in younger patients. The clinical presentation can vary, with symptoms mimicking metastatic disease. Even after parathyroidectomy, the condition may not fully resolve.
Early recognition and intervention of brown tumors in ESRD patients on maintenance hemodialysis is crucial, especially when they present with elevated calcium and phosphorus levels.
棕色瘤（纤维囊性骨炎）是一种与甲状旁腺功能亢进相关的良性骨病变，可影响终末期肾病（ESRD）患者的多根骨骼。
我们报告一例32岁维持性血液透析的ESRD女性患者，她出现全身疼痛、肌肉无力、便秘和情绪波动3个月。
初步检查显示甲状旁腺激素（PTH）、血清钙和磷水平升高。锝-99m甲氧基异丁基异腈扫描在左甲状腺叶下极发现一个甲状旁腺腺瘤。
尽管采取了保守治疗，但2年后她接受了甲状旁腺切除术，活检显示甲状旁腺增生。术后，她的症状持续存在，实验室检查显示PTH升高、血清钙降低和磷正常。再次进行的甲氧基异丁基异腈扫描在右甲状腺叶发现一个新的腺瘤，在下颌骨发现一个棕色瘤。X线显示左肱骨骨折，骨扫描显示颅骨、下颌骨和多个关节摄取增加。
甲状旁腺腺瘤的存在、PTH水平升高、需要透析的慢性肾病以及特定的影像学表现提示可能诊断为骨棕色瘤。该病例说明了ESRD患者甲状旁腺功能亢进管理的复杂性，尤其是在年轻患者中。临床表现可能各异，症状可类似转移性疾病。即使甲状旁腺切除术后，病情也可能无法完全缓解。
对于维持性血液透析的ESRD患者，早期识别和干预棕色瘤至关重要，尤其是当他们出现钙和磷水平升高时。
