Parathyroid adenoma with secondary osteoporosis and brown tumor

Case contributed by Dr Abdallah Alqudah


History of fall. According to the patient, this was a "minor" trauma. There is also past (not documented) history of total thyroidectomy.

Patient Data

Age: 50 years
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. Most likely representing brown tumor.

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 tumor), are highly suggestive of osteomalacia.

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

Surgery was performed, and pathology confirmed parathyroid adenoma.

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