Multiple Brown Tumors in Primary Hyperparathyroidism Causing Pathological Fracture: A Case Report of a 21-Year-Old Adult Male

Abstract

Multiple brown tumors are more common in females and older age groups and an unlikely site is the long bones. We report a case of a 21-year-old male presenting with a pathological fracture at the left neck of the femur. Laboratory investigations showed elevated parathyroid hormone (PTH) and serum calcium levels (PTH-dependent hypercalcemia). A CT scan revealed multiple osteolytic lesions in the pelvis and femurs, and a Tc-99m sestamibi scan showed a solitary parathyroid adenoma. We demonstrate this rare case and illustrate the importance of the consideration of multiple brown tumors in young males presenting with multiple osteolytic lesions at the long bones in the differential diagnosis. Every physician needs to have a high clinical suspicion of primary hyperparathyroidism innovation, in those who present with osteolytic lesions, with respect to the patient's age and gender.

Keywords: brown tumor; long bone fractures; osteitis fibrosa cystica; parathyroid gland adenoma; pathological fracture; primary hyperparathyroidism.

Figure 1. Plain radiograph of the pelvis: left neck of femur fracture, left protrusio acetabuli, and osteolytic lesion in the right neck of femur region

Figure 2. An axial CT scan of the pelvis revealed multiple osteolytic lesions and an acetabular protrusion

Figure 3. CT scan of the pelvis: coronal view, with red circle showing multiple osteolytic lesions and protrusion acetabuli and green circle showing a left neck of femur fracture

Figure 4. MRI hip: coronal T2 view showing multiple cystic lesions in the left acetabulum and right neck of femur region

Figure 5. Bone scan showing increased uptake in the pelvic region, femur, ribs, and tibia

Figure 6. Sestamibi scan showed increased uptake at the right parathyroid

Figure 7. Plain radiograph of the pelvis: post left cephalomedullary nail and right proximal femoral nail insertion