Successful treatment of severe secondary hyperparathyroidsm (Brown tumor) by kidney transplantation and pulses of oral calcitriol

Dental management of patients with renal diseases or undergoing renal transplant

BACKGROUND

The kidneys carry out many essential processes. A reduced glomerular filtration rate is the primary cause of renal failure. Patients with chronic kidney disease are significantly increasing all around the world. Patients with varying degrees of renal disease will be seen on the dental chair, and the dentist must be aware of dental considerations when treating such patient. Dental clinicians should carefully evaluate the oral findings and general condition of the renal disease patient.

OBJECTIVE

To increase the awareness of dentists in the dental management of patients with renal diseases or undergoing renal transplant.

METHODS

This study reviews 56 articles searched on two databases PubMed and Google Scholar with English language.

CONCLUSION

Every dentist should be well-informed regarding dental considerations and oral manifestations when treating a patient with any renal disease. Simple treatment plan modification can prevent the evolution of mild to critical medical or dental complications in renal disease patients.

Sarcoma-like pyogenic granuloma of the thumb and respiratory restrictive syndrome in a non-compliant hemodialysis patient

Pyogenic granuloma is a benign vascular tumor of the skin or mucosae usually observed after irritative processes. We report the case of a non-compliant hemodialysis patient with severe hyperparathyroidism who rapidly developed growing pyogenic granuloma of the distal part of the left thumb. This tumor mimicked sarcoma and caused recurrent bleeding during hemodialysis sessions. Hand radiograph revealed an osteolytic lesion compatible with a brown tumor. Among other brown tumors, several of those found in the ribs were responsible of a severe respiratory restrictive deficit. This report highlights the difficulty to choose the adequate treatment of severe hyperparathyroidism, and discusses the benefit/risk balance of performing parathyroidectomy.

Atypical presentation of a brown tumor in a kidney transplant recipient: a case report

Brown tumor is a rare complication of secondary hyperparathyroidism. It is exceptionally encountered after kidney transplantation. We here report on a 54-year-old male recipient who developed a brown tumor localized in the right forearm, and whose initial presentation was atypical, mimicking a bone tumor. Hence, diagnosis of brown tumors should be suggested by clinicians in a context of hyperparathyroidism.

Maxillary and orbital brown tumor of primary hyperparathyroidism

BACKGROUND

Brown tumors have rarely been described as involving the orbital bones. In this article we present the radiological and clinical properties, diagnosis and treatment of an orbital brown tumor case with primary HPT caused by parathyroid adenoma.

CASE REPORT

A 38-year-old woman presented with left-sided facial pain and history of leg pain from 1.5 years before that time, with walking difficulties. In imaging, left maxillary erosion was found. She underwent an excisional biopsy and the mass was diagnosed histologically as eosinophilic granuloma. A few months later the patient had right-sided facial pain again and progressive visual loss. In images, fluid-fluid level was noted in the cystic component of the mass. Right side exophthalmus and downward deviation of the globe was seen. Magnetic resonance imaging showed a well-defined extra-conal complex mass, with hypointense on T-1 and hyperintense on T-2 weighted images with fluid-fluid levels. Postoperatively the patients vision improved dramatically. Excision of the parathyroid adenoma normalized her metabolic status.

CONCLUSIONS

Brown tumor is an extremely rare manifestation of primary HPT. Delay in diagnosis can result in unnecessary complications. The management is multi-disciplinary, and therapeutic options should target the underlying cause.