A case of mediastinal parathyroid adenoma presenting as fracture of brown tumor / 대한내과학회지

ABSTRACT

Primary hyperparathyroidism is characterized by hypercalcemia and increased intact parathyroid hormone, and associated with reduced bone density and bony change. We experienced the case of a 18-year-old man presenting as fracture of brown tumor. And then ectopic superior mediastinal parathyroid adenoma was detected by preoperative localization studies (Tc-99m sestamibi scan, neck CT). The patient presented with fracture of the right 5th proximal phalanx which was brown tumor, and was diagnosed as having primary hyperparathyroidism due to elevated serum calcium level (12.1 mg/dl) and intact parathyroid hormone levels (1631.8 pg/ml). Ultrasonography, Tl-201/Tc-99m subtraction scan, Tc-99m sestamibi scan, computed tomography was performed, and then revealed an enlarged parathyroid gland in the superior mediastinum. Tumor was removed via a transcervical approach. Pathologically, the tumor was confirmed to be a parathyroid adenoma. After his operation, his calcium level rapidly returned to within normal ranges, and increased bone density and some remineralization of brown tumor has occurred after eight months.