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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) An unusual presentation of primary hyperparathyroidism: multiple brown tumors an...
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Vol. 35. Issue 5.
Pages 321-324 (September - October 2016)
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Vol. 35. Issue 5.
Pages 321-324 (September - October 2016)
Clinical note
An unusual presentation of primary hyperparathyroidism: multiple brown tumors and coexisting thyroid carcinoma
Presentación inusual de hiperparatiroidismo primario: múltiples tumores pardos y coexistencia de carcinoma tiroideo
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Y. Basaranb, S. Incea, E. Alagoza,
Corresponding author
ealagoz@gata.edu.tr

Corresponding author.
, C. Mericb, A. Taslipinarb
a Gulhane Military Medical Academy and School of Medicine, Department of Nuclear Medicine, Etlik, Ankara, Turkey
b Gulhane Military Medical Academy and School of Medicine, Department of Endocrinology and Metabolism, Etlik, Ankara, Turkey
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Abstract

We present a patient with a complex clinical picture of primary hyperparathyroidism with multiple destructive skeletal lesions suspicious of bone metastases and concomitant multifocal papillary thyroid carcinoma with a metastatic central lymph node. He presented with progressively worsening right hip pain and restricted motion. Magnetic resonance imaging revealed multiple lytic lesions involving predominantly the right trochanter minor and the left inferior and posterior pubic rami. Biochemical tests were consistent with primary hyperparathyroidism. Neck ultrasound and parathyroid scintigraphy revealed a single parathyroid adenoma and a thyroid nodule, preoperative cytology of which confirmed papillary thyroid carcinoma, as did the final surgical specimen. Biochemical results, regarding hyperparathyroidism, declined to normal levels and his complaints gradually decreased after surgery. Postoperative whole body bone scintigraphy showed increased tracer uptakes at multiple sites, but they were proved to be metabolically inactive by fluorodeoxyglucose positron emission tomography/computed tomography.

Keywords:
Parathyroid adenoma
Brown tumor
Bone scintigraphy
FDG PET/CT
Resumen

Presentamos el caso de un paciente con un cuadro clínico de hiperparatiroidismo primario, con muchas lesiones óseas destructivas sospechosas de metástasis óseas y carcinoma tiroideo multifocal concomitante con un ganglio linfático metastásico central. Se presentó con agravamiento progresivo de dolor y restricción de movimiento en la cadera derecha. La resonancia magnética reveló múltiples lesiones líticas que implicaban principalmente al trocánter menor derecho y a las ramas púbicas izquierdas inferior y posterior. Las pruebas bioquímicas fueron consistentes con un hiperparatiroidismo primario. La ecografía cervical y la gammagrafía paratiroidea revelaron un único adenoma paratiroideo y un nódulo tiroideo, cuya citología preoperatoria confirmó un carcinoma papilar de tiroides, que fue confirmado también por la muestra final obtenida quirúrgicamente. Los resultados bioquímicos, en relación con el hiperparatiroidismo, descendieron a niveles normales tras la cirugía, y los dolores fueron remitiendo gradualmente. La gammagrafía ósea postoperatoria de cuerpo entero reflejó un incremento de captación del radiotrazador en múltiples localizaciones, que resultaron ser metabólicamente inactivas en la tomografía por emisión de positrones con fluorodesoxiglucosa/tomografía computarizada.

Palabras clave:
Adenoma paratiroideo
Tumor pardo
Gammagrafía ósea
FDG PET/TC

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