SECONDARY HYPERPARATHYROIDISM AND MULTIPLE VERTEBRAL BROWN TUMORS IN A DIALYSIS PATIENT - A CASE-REPORT

A 46 year old man was referred for severe left cruralgia and multiple Vertebral cystic defects on CT-scan. He was treated by hemodialysis si nce 1987 for chronic renal failure secondary to focal and segmental gl omerulosclerosis, diagnosed in 1960 on renal biopsy. Dialysis schedule consisted of 3x4 h/week with a polysulfone dialyser and 1.75 mMol Ca containing bicarbonate dialysate. On early 1995, the patient complaine d of back pain and cruralgia, which gradually worsned. Vertebral colum n CT-scan and MRI showed multiple lytic lesions expanding into the med ullary canal. Biological hyperparathyroidism was present. To different iate between hyperparathyroidism with brown tumors, malignancy and amy loid deposition, an iliac biopsy and a biopsy of a corporeal vertebral cyst were done. They showed florid hyperparathyroidism and brown tumo rs. The patient was submitted to surgical parathyroidectomy. Six month s after surgery, cruralgia resumed, CT-scan and MRI showed refilling o f the cysts by calcic material.