말기 신부전 환자에서 이차성 부갑상선 기능 항진증과 연관하여 상악골에 발생한 갈색종의 7년간 추적 결과 1예
Seven Year-follow-up of a Brown Tumor in the Maxilla Associated with Secondary Hyperparathyroidism in End-stage Renal Failure
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초록
저자들은 만성 신부전으로 인한 부갑상선 기능 항진증의 드문 합병증인 상악골의 갈색종을 진단하였고, 부갑상선 절제술 시행 후 갈색종의 지속적인 크기 감소가 관찰되었다. 이차성 부갑상선 기능 항진증으로 인한 갈색종을 수술적인 치료 없이 7년간의장기간 추적 관찰을 통하여 크기의 감소와 통증의소실 등의 호전을 경험하였기에 보고하는 바이다.
Abstract
Hyperparathyroidism is a frequent complication of chronic kidney disease (CKD) as a result of prolonged hyperphosphatemia and hypocalcemia. Brown tumor is a rare bony complication of hyperparathyroidism as a result of increased osteoclastic activity and fibroblastic proliferation. Frequent sites of brown tumor are known as ribs, clavicles, mandible, and pelvic bone, but maxilla is very rare site. Twenty sevenyear-old woman with stage V CKD on hemodialysis presented with maxillary mass which had gradually increased in size for 3 years. It was painless, but tooth derangement occurred. Initial laboratory findings revealed hypercalcemia (11.0 mg/dL), hyperphosphatemia (6.9 mg/dL), high creatinine (7.5 mg/dL), and high serum PTH (1729.9 pg/mL). The bone mineral density was significantly low (lumbar spine Z-score: -4.1,femur neck Z-score: -4.5). Radiologically, there were resorptive lesions in the maxilla. We performed total parathyroidectomy with transplanting half of her parathyroid gland on her right forearm. After surgery,serum PTH was markedly decreased to normal level. Immediate post-operative hypocalcemia developed without any change in serum Pi, then calcium gradually normalized. Seven years after the parathyroid surgery, she finally underwent renal transplantation that lead her calcium, phosphate and creatinine corrected to normal range, and the size of brown tumor has decreased further more. We report a case of long term follow up on a brown tumor in the maxilla which is infrequent site finally recovered.
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