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KMID : 1100120200270030217
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대한골대사학회지
2020 Volume.27 No. 3 p.217 ~ p.226
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Three Rare Concurrent Complications of Tertiary Hyperparathyroidism: Maxillary Brown Tumor, Uremic Leontiasis Ossea, and Hungry Bone Syndrome
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Bransky Natalie
Iyer Neena Ramesh
Cannon Sophie Mestman
Tyan Alexander Hanlin
Mylavarapu Praneet
Orosco Ryan
Hom David Brain
Moazzam Alan Ali
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Abstract
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A 48-year-old woman in her 40’s with end-stage renal disease and tertiary hyperparathyroidism (HPT) presented for a rapidly progressive maxillary tumor. Initial workup was notable for elevated intact parathyroid hormone (PTH) and diffuse thickening of skull and facial bones on computed tomography, and maxillary tumor biopsy with multinucleated giant cells. She underwent subtotal parathyroidectomy (with removal of a parathyroid adenoma and 2 hyperplastic glands) and partial resection of maxillary brown tumor. The patient’s post-operative course was complicated by hungry bone syndrome, with hypocalcemia refractory to aggressive calcium repletion. Teriparatide (recombinant PTH) was utilized with rapid resolution of hypocalcemia. To our knowledge, this is the first case of maxillary brown tumor in tertiary HPT to be reported in the USA. This case also supports teriparatide as a novel therapeutic for hungry bone syndrome refractory to aggressive calcium repletion.
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KEYWORD
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Brown tumor, Hungry bone syndrome, Maxilla, Teriparatide, Tertiary hyperparathyroidism, Uremic leontiasis ossea
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