Brown Tumor – a Rare Manifestation of Renal Osteodystrophy and Severe Secondary Hyperparathyroidism: Case Report

Multifactorial disorders in mineral metabolism and bone structure occur early in the course of chronic kidney disease. The new term of ‘chronic kidney disease – mineral and bone disorders’ has been used to encompass a broad syndrome in which various abnormalities in bone and mineral metabolism are present in patients with chronic kidney disease. Brown tumors are an uncommon type of bone lesions that represent a focal manifestation of high-turnover bone disease. In our report, we describe a patient with chronic kidney disease on chronic hemodialysis that presented with multiple osseous lesions of the right elbow, right scapula and ribs. This case illustrates the importance of taking brown tumor in consideration in differential diagnosis and management of patients with an osseous mass and chronic kidney disease, where a failure to establish an accurate diagnosis can lead to unnecessary further diagnostic procedures and even extensive surgery, increasing the morbidity of these patients. Prevention, early diagnosis and treatment of secondary hyperparathyroidism are important in reducing the prevalence of high-turnover bone disease and consequential bone lesions including brown tumors.
Multifaktorijalni poremećaji mineralnog metabolizma i koštane strukture javljaju se rano u razvoju kronične bubrežne bolesti. Novi pojam „kronična bubrežna bolest – mineralni i koštani poremećaji“ rabi se kako bi obuhvatio širok sindrom različitih abnormalnosti mineralnog i koštanog metabolizma koje nalazimo kod bolesnika s kroničnom bubrežnom bolešću. Smeđi tumori su rijetki koštani poremećaji koji predstavljaju žarišnu manifestaciju bolesti prekomjerne koštane pregradnje. Prikazan je slučaj bolesnice s kroničnom bubrežnom bolešću na programu kronične hemodijalize, koja je primljena s višestrukim koštanim lezijama u području desnog lakta, desne lopatice i rebara. Rad ukazuje na važnost razmatranja smeđeg tumora u diferencijalnoj dijagnostici bolesnika s koštanim masama i kroničnom bubrežnom bolešću, kada propust u postavljanju ispravne dijagnoze može dovesti do nepotrebnih dodatnih dijagnostičkih postupaka, pa čak i do opsežnih operativnih zahvata, povećavajući tako pobol. Prevencija, rana dijagnostika i liječenje sekundarnog hiperparatiroidizma je važno za smanjivanje učestalosti bolesti pretjerane koštane pregradnje i posljedičnih koštanih bolesti uključujući smeđi tumor.