Parathyroid adenoma with secondary osteoporosis and brown tumour

Case contributed by Dr Abdullah Alqudah

Presentation

50 year old female patient with history of falling down. According to the patient, this was a "minor" trauma. There is also past (not documented) history of total thyroidectomy.

Patient Data

Age: 50 years old
Gender: Female

Multiple radiolucent cortical and sub-cortical lines with surrounding sclerosis noted in most of the long bones of the body characteristics of Looser zones. Some of the fractures are displaced and angulated. Diffusely osteopenic bones.   

 

Radiolucent cortical and subcortical line with surrounding sclerosis noted at the metadiaphysis of the right ulna.

Evidence of well-defined, enhancing, rounded, heterogeneous soft tissue mass lesions seen in the region of the left thyroid lobe.

There is well-defined cortical based osteolytic lesion seen in the right body of the mandible. Mostly representing brown tumour.

Severe osteopenia involving the examined bone.

Nonvisualization of the thyroid gland consistent with a history of total thyroidectomy, parts of the isthmus is seen maybe residual thyroid tissue.

Case Discussion

This patient presents after minor trauma. She provides a history of total thyroidectomy many years ago. On physical exam, there was a palpable left neck mass. Lab findings show an increase in serum calcium and parathyroid hormone (PTH).

The diffuse decrease in bone density, multiple bone fractures which are out of proportion to the severity of the trauma, the characteristic Looser zone fracture and the right mandible osteolytic bony lesion (most likely a brown tumour), are highly suggestive of osteomalacia.

With correlation of the clinical setting and radiology, this lesion most likely parathyroid adenoma with a secondary brown tumour.

Surgery was performed, and pathology confirmed parathyroid adenoma.

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Case information

rID: 48767
Case created: 23rd Oct 2016
Last edited: 13th Jan 2017
Inclusion in quiz mode: Included

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