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
Date of Acceptance: 08-Jun-2010
Code Number: ni10125
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. , The patient usually presents with symptoms of compression of the nearby structures.
Copyright 2010 - Neurology India
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Photo images[ni10125f3.jpg] [ni10125f2.jpg] [ni10125f1.jpg]