A CASE WITH UREMIC BONE DISEASE ASSOCIATED WITH BROWN TUMORS AFTER INSUFFICIENT PARATHYROIDECTOMY

Almost ten percent of the patients with highturnover uremic bone disease have brown tumors. We present here a 63-year-old male patient, on regular hemodialysis for twelve years, with subcutaneous tumoral masses appeared after subtotal thyroidectomy performed to excise four parathyroid adenomas two years ago. The patient, lost for follow-up for two years, was admitted to hospital with the complaints of severe itching, fatigue and two solid masses located, on bilateral sterno-clavicular junction two years after surgical procedure. Examinations showed a permanent pacemaker, CaxP product: 82, parathormone level (PTH): 1991 pg/ml and two residual adenomas confirmed with Tc99m MIBI (methoxyisobulil isonitrile) parathroid scintigraphy. Brown tumors were diagnosed by tru-cut biopsies of the lesions and pulmonary uptake was demonstrated in lung scintigraphy. The PTH levels returned to normal, persistant itching and fatigue disappeared after excisions of residual parathyroid adenomas and sternoclavicular lesions.