Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 58, Num. 3, 2010, pp. 487-488

Neurology India, Vol. 58, No. 3, May-June, 2010, pp. 487-488

Letter To Editor

Bumps on the head: Brown tumors of hyperparathyroidism

Rahat Brar¹, Abhishek Prasad¹, Raman Chawla¹, Tarun Sharma²

¹ Department of Radiology, Fortis Hospital, Sector 62, Phase 8, Mohali - 160 062, Punjab, India
² Department of Neurosurgery, Fortis Hospital, Sector 62, Phase 8, Mohali - 160 062, Punjab, India
Correspondence Address: Rahat Brar, Department of Radiology, Fortis Hospital, Sector 62, Phase 8, Mohali - 160 062, Punjab, India, dr_rahatbrar@yahoo.com

Date of Acceptance: 08-Jun-2010

Code Number: ni10125

PMID: 20644288
DOI: 10.4103/0028-3886.65518

Sir,

A 28-year-old previously healthy woman presented with a 1-year history of progressively increasing hard swellings on her head with headaches. On initial examination, she had multiple bony swellings on the scalp. Neurologic examination was normal. Computerized tomography scan of the head revealed multiple well-defined expansile, lytic calvarial lesions involving the bilateral frontal and parietal bones. [Figure - 1], [Figure - 2], [Figure - 3] The biochemical parameters, including serum calcium (14.9 mg/dL [normal, 8-10.5 mg/dL]), alkaline phosphatase (825 U/L [normal, 30-120 U/L]), serum parathyroid hormone (PTH; 1260 pg/L [normal, 10-60 pg/mL]) were raised. She had low levels of inorganic phosphorus (2.2 mg/dL [normal, 3.0-4.5 mg/dL]).

Ultrasound neck revealed a 6 Χ 8 Χ 3 mm hypoechoic lesion on the right side near the posteroinferior surface of the thyroid gland. Fine-needle aspiration cytology confirmed the diagnosis of a parathyroid adenoma. The patient underwent surgery and a right lower parathyroidectomy was performed. In the same sitting, biopsy from the frontal skull swelling was done. Pathologic examination confirmed the diagnosis of osteitis fibrosa cystica (brown tumor of hyperparathyroidism). After surgery, the serum PTH (49 pg/mL) and serum calcium (10.3 mg/dL) returned to normal.

Brown tumors of the skull, facial bones, and the orbits are not uncommon. ^[1],[2] The patient usually presents with symptoms of compression of the nearby structures.

References

1.	Goswami P, Sarma PK, Sethi S, Hazarika S. Skeletal manifestations in a case of primary hyperparathyroidism caused by parathyroid adenoma. Indian J Radiol Imaging 2002;12:267-70.  Back to cited text no. 1
2.	Yilmazlar S, Arslan E, Aksoy K, Tolunay S. Sellar-parasellar brown tumor: Case report and review of literature. Skull Base 2004;14:163-8.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]

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