Session: SUN 234-256-Bone & Calcium Metabolism: Clinical Trials & Case Series
Poster Board SUN-241
Clinical Cases: Case 1 is a 27-yr-old man with 2-mo history of painless right inferior jaw mass followed by proximal weakness and polyuria. Blood analyses revealed: total serum calcium levels (Ca) 14.2 mg/dl (ref range 8.6-10.2), phosphate (P) 2.1 mg/dl (2.7-4.5), alkaline phosphatase (AP) 450 U/L (40-129) and PTH 1,217 pg/ml (16-87). CT scan revealed lytic lesions in the mandible and maxilla, with max 35 mm diameter. Biopsy showed a giant cell lesion compatible with BT, excluding ossifying fibromas typical of HPT-jaw tumor syndrome.
Case 2 is a 37-yr-old woman with 7-mo history of right mandibular painful swelling, weakness and memory loss. Blood tests showed Ca 14.0 mg/dl, P 2.2 mg/dl, AP 618 U/L, and PTH 2,399 pg/ml. Head CT revealed multiple lytic expansive bone lesions, the 2 largest in the right maxilla and mandible (24 and 21 mm), confirmed to be giant cell lesions by biopsy.
Case 3 is a 32-yr-old woman with 2-yr history of an enlarging cervical nodule followed by progressive weakness and muscular pain. She complained of a painful swelling of the right inferior gum in the previous month. Blood tests revealed Ca 15.7 mg/dl, P 2.0 mg/dl, AP 580 U/L, and PTH 1,472 pg/ml. Head CT showed mandibular and maxillary expansive lytic lesions with up to 35 mm, confirmed to be giant cell lesions.
All 3 subjects had multiple skeletal lytic lesions, low BMD in the distal radius (Z-score -6.4, -4.0, and -4.6 respectively) and negative screening for familial forms of PHPT. Single parathyroid (PT) adenomas measuring 33, 40 and 71 mm, respectively, were surgically resected, leading to resolution of PHPT.
Clinical Lesson: We describe 3 cases of rapid-onset PHPT presenting at young age with severe biochemical and skeletal disease, including histologically confirmed BTs in facial bones. Other rare reports in the literature with similar presentation suggest that a more aggressive form of PHPT with facial BTs might be more frequent in a younger population, potentially due to different mechanisms of disease.
Nothing to Disclose: MGR, AMF, PHSC, BF
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