Supra-Acetabular Brown Tumor due to Primary Hyperparathyroidism Associated with Chronic Renal Failure
A 63-year-old woman presented to the Orthopedic Unit of our hospital complaining of right hip pain of 6 months'duration associated with a worsening limp. Her past medical history included chronic renal insufficiency. Physical examination revealed deep pain in the iliac region and severe restric...
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| Format: | Article |
| Language: | English |
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Wiley
2010-01-01
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| Series: | The Scientific World Journal |
| Online Access: | http://dx.doi.org/10.1100/tsw.2010.86 |
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| author | Rosaria M. Ruggeri Emanuele Calamoneri Antonia Russo Alessandro Sindoni Baldassarre Mondello Maurizio Monaco Michele A. Rosa Sergio Baldari Salvatore Benvenga Alfredo Campennì Francesco Trimarchi |
| author_facet | Rosaria M. Ruggeri Emanuele Calamoneri Antonia Russo Alessandro Sindoni Baldassarre Mondello Maurizio Monaco Michele A. Rosa Sergio Baldari Salvatore Benvenga Alfredo Campennì Francesco Trimarchi |
| author_sort | Rosaria M. Ruggeri |
| collection | DOAJ |
| description | A 63-year-old woman presented to the Orthopedic Unit of our hospital complaining of right hip pain of 6 months'duration associated with a worsening limp. Her past medical history included chronic renal insufficiency. Physical examination revealed deep pain in the iliac region and severe restriction of the right hip's articular function in the maximum degrees of range of motion. X-rays and CT scan detected an osteolytic and expansive lesion of the right supra-acetabular region with structural reabsorption of the right iliac wing. 99mTc-MDP whole-body bone scan showed an abnormal uptake in the right iliac region. Bone biopsy revealed an osteolytic lesion with multinucleated giant cells, indicating a brown tumor. Serum intact PTH was elevated (1020 pg/ml; normal values, 12 62 pg/ml), but her serum calcium was normal (total = 9.4 mg/dl, nv 8.5–10.5; ionized = 5.0 mg/dl, nv 4.2–5.4) due to the coexistence of chronic renal failure. 99mTc-MIBI scintigraphy revealed a single focus of sestamibi accumulation in the left retrosternal location, which turned out to be an intrathoracic parathyroid adenoma at surgical exploration. After surgical removal of the parathyroid adenoma, PTH levels decreased to 212 pg/ml. Three months after parathyroidectomy, the imaging studies showed complete recovery of the osteolytic lesion, thus avoiding any orthopedic surgery. This case is noteworthy because (1) primary hyperparathyroidism was not suspected due to the normocalcemia, likely attributable to the coexistence of chronic renal failure; and (2) it was associated with a brown tumor of unusual location (right supra-acetabular region). |
| format | Article |
| id | doaj-art-319d7b7c47114417b08cd511b0080401 |
| institution | Kabale University |
| issn | 1537-744X |
| language | English |
| publishDate | 2010-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | The Scientific World Journal |
| spelling | doaj-art-319d7b7c47114417b08cd511b00804012025-02-03T05:50:43ZengWileyThe Scientific World Journal1537-744X2010-01-011079980510.1100/tsw.2010.86Supra-Acetabular Brown Tumor due to Primary Hyperparathyroidism Associated with Chronic Renal FailureRosaria M. Ruggeri0Emanuele Calamoneri1Antonia Russo2Alessandro Sindoni3Baldassarre Mondello4Maurizio Monaco5Michele A. Rosa6Sergio Baldari7Salvatore Benvenga8Alfredo Campennì9Francesco Trimarchi10Department of Clinical-Experimental Medicine and Pharmacology, Division of Endocrinology, University of Messina, Messina, ItalyDepartment of Surgical Sciences, University of Messina, Messina, ItalyDepartment of Clinical-Experimental Medicine and Pharmacology, Division of Endocrinology, University of Messina, Messina, ItalyDepartment of Radiological Sciences, Division of Nuclear Medicine, University of Messina, Messina, ItalyDivision of Cardiovascular and Thoracic Sciences, University of Messina School of Medicine, Messina, ItalyDivision of Cardiovascular and Thoracic Sciences, University of Messina School of Medicine, Messina, ItalyDepartment of Surgical Sciences, University of Messina, Messina, ItalyDepartment of Radiological Sciences, Division of Nuclear Medicine, University of Messina, Messina, ItalyDepartment of Clinical-Experimental Medicine and Pharmacology, Division of Endocrinology, University of Messina, Messina, ItalyDepartment of Radiological Sciences, Division of Nuclear Medicine, University of Messina, Messina, ItalyDepartment of Clinical-Experimental Medicine and Pharmacology, Division of Endocrinology, University of Messina, Messina, ItalyA 63-year-old woman presented to the Orthopedic Unit of our hospital complaining of right hip pain of 6 months'duration associated with a worsening limp. Her past medical history included chronic renal insufficiency. Physical examination revealed deep pain in the iliac region and severe restriction of the right hip's articular function in the maximum degrees of range of motion. X-rays and CT scan detected an osteolytic and expansive lesion of the right supra-acetabular region with structural reabsorption of the right iliac wing. 99mTc-MDP whole-body bone scan showed an abnormal uptake in the right iliac region. Bone biopsy revealed an osteolytic lesion with multinucleated giant cells, indicating a brown tumor. Serum intact PTH was elevated (1020 pg/ml; normal values, 12 62 pg/ml), but her serum calcium was normal (total = 9.4 mg/dl, nv 8.5–10.5; ionized = 5.0 mg/dl, nv 4.2–5.4) due to the coexistence of chronic renal failure. 99mTc-MIBI scintigraphy revealed a single focus of sestamibi accumulation in the left retrosternal location, which turned out to be an intrathoracic parathyroid adenoma at surgical exploration. After surgical removal of the parathyroid adenoma, PTH levels decreased to 212 pg/ml. Three months after parathyroidectomy, the imaging studies showed complete recovery of the osteolytic lesion, thus avoiding any orthopedic surgery. This case is noteworthy because (1) primary hyperparathyroidism was not suspected due to the normocalcemia, likely attributable to the coexistence of chronic renal failure; and (2) it was associated with a brown tumor of unusual location (right supra-acetabular region).http://dx.doi.org/10.1100/tsw.2010.86 |
| spellingShingle | Rosaria M. Ruggeri Emanuele Calamoneri Antonia Russo Alessandro Sindoni Baldassarre Mondello Maurizio Monaco Michele A. Rosa Sergio Baldari Salvatore Benvenga Alfredo Campennì Francesco Trimarchi Supra-Acetabular Brown Tumor due to Primary Hyperparathyroidism Associated with Chronic Renal Failure The Scientific World Journal |
| title | Supra-Acetabular Brown Tumor due to Primary Hyperparathyroidism Associated with Chronic Renal Failure |
| title_full | Supra-Acetabular Brown Tumor due to Primary Hyperparathyroidism Associated with Chronic Renal Failure |
| title_fullStr | Supra-Acetabular Brown Tumor due to Primary Hyperparathyroidism Associated with Chronic Renal Failure |
| title_full_unstemmed | Supra-Acetabular Brown Tumor due to Primary Hyperparathyroidism Associated with Chronic Renal Failure |
| title_short | Supra-Acetabular Brown Tumor due to Primary Hyperparathyroidism Associated with Chronic Renal Failure |
| title_sort | supra acetabular brown tumor due to primary hyperparathyroidism associated with chronic renal failure |
| url | http://dx.doi.org/10.1100/tsw.2010.86 |
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