Two rare manifestations of primary hyperparathyroidism: paralysis and peptic ulcer bleeding

摘要

Primary hyperparathyroidism revealed by thoracic spine brown tumor and peptic ulcer bleeding is rare. We presented a case of 33-year-old male patient who was admitted with paraplegia. Thoracic spine magnetic resonance imaging (MRI) showed extradural lesion at T4 level. He underwent surgical decompression in T4. According to histopathologic finding and elevated serum parathormone (PTH) and hypercalcemia (total serum calcium 12.1 mg/dL), the diagnosis of brown tumor was down. Ultrasonography of his neck showed a well-defined lesion of 26 × 14 × 6 mm. The day after surgery, he experienced 2 episodes of melena. Bedside upper gastrointestinal endoscopy showed gastric peptic ulcer with visible vessel. Treatment with intragastric local instillation of epinephrine and argon plasma coagulation was done to stop bleeding. After stabilization of the patient, parathyroidectomy was performed. Histologic study showed the parathyroid adenoma without any manifestation of malignancy. At discharge, serum calcium was normal (8.6 mg/dL). On 40th day of discharge, standing and walking status was normal.Learning points: class="unordered" style="list-style-type:disc">Thoracic spine involvement is a very rare presentation of primary hyperparathyroidism.The issue of whether primary hyperparathyroidism increases the risk of peptic ulcer disease remains controversial. However, gastrointestinal involvement has been reported in association with classic severe primary hyperparathyroidism.The treatment of brown tumor varies from case to case. class="head no_bottom_margin" id="__sec2title">BackgroundBrown tumor (also called ‘osteoclastoma’) is a benign lytic bone lesion due to primary or secondary hyperparathyroidism. Brown color of this tumor is due to the accumulation of osteoclast, blood and fibrous tissue (). It is found in up to 3% of hyperparathyroidism (). This tumor-like lesion may be presented as a solitary or multiple mass that involve bone and adjacent tissues. It rarely locates in the spine (). To our best knowledge, the case reports of thoracic spine brown tumor due to primary hyperparathyroidism were very rare. Spinal involvement by brown tumor occasionally causes acute neurological deterioration (). We present a case of paralysis due to brown tumor involving the thoracic spine in a patient with primary hyperparathyroidism.