Multiple Giant Brown Tumors in a Patient with Secondary Hyperparathyroidism: A Case Report on Successful Treatment after Total Parathyroidectomy and Autotransplantation

Background: Brown tumours (BT) are benign bone lesions that may appear in the context of primary and secondary hyperparathyroidism, as unifocal or multifocal bone lesions, they represent a serious complication of advanced hyperparathyroidism. They are considered as a reparative cellular process rather than real neoplasia. This phenomenon is considered as pathognomonic of hyperparathyroidism secondary to renal failure, especially in patients on long-term hemodialysis. Secondary hyperparathyroidism is a frequently encountered problem in the management of patients with end stage renal disease on haemodialysis. Its pathophysiology is mainly due to hyperphosphatemia and vitamin D deficiency and resistance. This condition has a high impact on the mortality and morbidity of dialysis patients. The treatment remains a challenge for both patients and their clinicians.
Case Report: Here we describe a case of a young man with end stage renal disease on haemodialysis, presented with multiple giant brown tumours localized to his upper and lower limbs due to secondary hyperparathyroidism. Hemodialysis and pharmacological treatment were unsuccessful in controlling the disease making it necessary to proceed with a total parathyroidectomy and deltoid muscle autotransplantation. The proper timing of the parathyroidectomy and its favorable effect on regression of the brown tumors made it possible to avoid a potentially extensive surgical removal of the brown tumors from the patients’ limbs.
Conclusion: The medical treatment of a brown tumour aims primarily to reduce the elevated parathyroid hormone levels by pharmacological treatment. Surgical treatment is reserved to nonresponders or symptomatic patients with painful swellings or those who have alterations of normal limbs or joint functions. Secondary hyperparathyroidism is a frequently encountered problem in the management of patients with end stage renal disease on dialysis. Its pathophysiology is mainly due to hyperphosphatemia and vitamin D deficiency and resistance. This condition has a high impact on the mortality and morbidity of dialysis patients. Early diagnosis and treatment of secondary hyperparathyroidism is crucial in the management of these patients.