Abstract
RATIONALE: Brown tumor (osteitis fibrosa cystica) is a benign bone lesion associated with hyperparathyroidism that can affect multiple bones in patients with end-stage renal disease (ESRD). PATIENT CONCERNS: We present the case of a 32-year-old female with ESRD on maintenance hemodialysis who experienced body aches, muscle weakness, constipation, and mood swings for 3 months. DIAGNOSES: Initial tests revealed elevated parathyroid hormone (PTH), serum calcium, and phosphorus levels. A technetium-99m sestamibi scan identified a parathyroid adenoma in the inferior pole of the left thyroid lobe. INTERVENTIONS: Despite conservative management, she underwent parathyroidectomy 2 years later, with biopsy showing parathyroid hyperplasia. Postoperatively, her symptoms persisted, and labs indicated elevated PTH, low serum calcium, and normal phosphorus. A repeat sestamibi scan detected a new adenoma in the right thyroid lobe and a brown tumor in the mandible. X-ray showed a left humerus fracture, and a bone scan revealed increased uptake in the skull, mandible, and multiple joints. OUTCOMES: The presence of a parathyroid adenoma, elevated PTH levels, chronic kidney disease requiring dialysis, and specific imaging findings suggest a potential diagnosis of brown tumor of the bone. This case illustrates the complexity of managing hyperparathyroidism in ESRD, particularly in younger patients. The clinical presentation can vary, with symptoms mimicking metastatic disease. Even after parathyroidectomy, the condition may not fully resolve. LESSONS: Early recognition and intervention of brown tumors in ESRD patients on maintenance hemodialysis is crucial, especially when they present with elevated calcium and phosphorus levels.