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Mishaela R. Rubin, Virginia A. LiVolsi, Francisco Bandeira, Gustavo Caldas, John P. Bilezikian, Tc99m-Sestamibi Uptake in Osteitis Fibrosa Cystica Simulating Metastatic Bone Disease, The Journal of Clinical Endocrinology & Metabolism, Volume 86, Issue 11, 1 November 2001, Pages 5138–5141, https://doi.org/10.1210/jcem.86.11.7994
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PRIMARY HYPERPARATHYROIDISM typically presents as an asymptomatic disorder of mild hypercalcemia (1). Severe parathyroid bone disease is rare since the advent of the multichannel autoanalyzer (1). However, osteitis fibrosa cystica, the classical bone disease of primary hyperparathyroidism (2), still occurs (3–9). The pathology involves excessive osteoclast resorption with destruction of cortical bone and creation of fibrous cysts. The marrow may be replaced by vascularized fibrous tissue and osteoclast-like giant cells. Blood pigment accumulates, imparting a reddish-brown hue and accounting for the term brown tumor (10). Occasionally, osteitis fibrosa cystica can be mistaken for a malignant lesion, even though it is reactive and clearly not neoplastic. On histological exam, the lesion may mimic a true giant cell tumor of bone (10). Radiologically, the multiple, osteolytic lesions may be indistinguishable from metastatic disease (11). Improvement and at times complete regression of the lesion occur after successful parathyroidectomy (12–14).
In parathyroid carcinoma, osteitis fibrosa cystica and other overt radiological signs of hyperparathyroid skeletal disease are much more common than in benign primary hyperparathyroidism (15–18). Although parathyroid carcinoma is a rare cause of PTH-dependent hypercalcemia (15, 19, 20), the associated hypercalcemia and bone disease are usually severe (21). As a result of the hypercalcemia, which can be marked, weakness, weight loss, anorexia, nausea, vomiting, polyuria, polydipsia, bone pain, and fracture frequently occur. Markedly high PTH and alkaline phosphatase levels are also found (22). As parathyroid cancer can metastasize to bone, it can be unclear in parathyroid carcinoma whether the bone lesions are from osteitis fibrosa cystica or metastatic parathyroid cancer.
