Brown tumours may occur secondary to hyperparathyroidism in patients with chronic renal failure (CRF). Diagnosing a spinal brown tumour causing cord compression requires a high index of suspicion. We report a 65-year-old woman, who had been on haemodialysis for CRF for over 10 years, who presented with leg weakness and back pain over the thoracolumbar junction. She had a brown tumour at T8 causing subacute spinal cord compression. Ambulation was regained after surgical decompression and stabilisation. Adherence to the National Kidney Foundation guidelines in the management of patients with CRF may prevent renal osteodystrophy. Treatment of spinal brown tumour depends on the severity of the neurological deficit. Remineralisaton is expected after correction of the parathyroid level, thus negating the need for total excision of the parathyroid glands.
MaitraAAbbasAK. The endocrine system. In: KumarVAbbasAKFaustoN, editors. Robbins & Cotran pathologic basis of disease, 7th ed.Philadelphia: Elsevier Saunders; 2005:1155–226.
2.
LessaMMSakaeFATsujiRKFilhoBCVoegelsRLButuganO. Brown tumor of the facial bones: Case report and literature review. Ear Nose Throat J2005;84:432–4.
3.
VandenbusscheESchmiderLMutschlerCManMJacquotCAugereauB. Brown tumor of the spine and progressive paraplegia in a hemodialysis patient. Spine2004;29:E251–5.
4.
JohnJ. Grading of muscle power: Comparison of MRC and analogue scales by physiotherapists. Medical Research Council. Int J Rehabil Res1984;7:173–81.
5.
SuetsunaFHarataSYoshimuraN. Influence of the ultrasonic surgical aspirator on the dura and spinal cord. An electrohistologic study. Spine1991;16:503–9.
6.
BalonPecovnik BKavalarR. Brown tumor in association with secondary hyperparathyroidism. A case report and review of the literature. Am J Nephrol1998;18:460–3.
7.
TarrassFAyadABenjellounMAnabiARamdaniBBenghanemMG. Cauda equina compression revealing brown tumor of the spine in a long-term hemodialysis patient. Joint Bone Spine2006;73:748–50.
HernandezJDWesselingKSaluskyIB. Role of parathyroid hormone and therapy with active vitamin D sterols in renal osteodystrophy. Semin Dial2005;18:290–5.
10.
KhanABilezikianJ. Primary hyperparathyroidism: Pathophysiology and impact on bone. CMAJ2000;163:184–7.
11.
EricssonMHolmEIngemanssonSLindholmTSvendgaardNA. Secondary hyperparathyroidism combined with uremia and giant cell containing tumor of the cervical spine. A case report. Scand J Urol Nehprol1978;12:185–7.
12.
BohlmanMEKimYCEaganJSpeesEK. Brown tumor in secondary hyperparathyroidism causing acute paraplegia. Am J Med1986;81:545–7.
13.
PumarJMAlvarezMPerez-BatallonAVidalJLadoJBollarA. Brown tumor in secondary hyperparathyroidism, causing progressive paraplegia. Neuroradiology1990;32:343.
14.
BarlowIWArcherIA. Brown tumor of the cervical spine. Spine1993;18:936–7.
15.
FinemanIJohnsonJPDi-PatrePLSandhuH. Chronic renal failure causing brown tumors and myelopathy. Case report and review of pathophysiology and treatment. J Neurosurg1999;90(2 Suppl):S242–6.
16.
AzriaABeaudreuilJJuquelJPQuillardABardinT. Brown tumor of the spine revealing secondary hyperparathyroidism. Report of a case. Joint Bone Spine2000;67:230–3.
17.
MasutaniKKatafuchiRUenoyamaKSaitoSFujimiSHirakataH. Brown tumor of the thoracic spine in a patient on long-term hemodialysis. Clin Nephrol2001;55:419–23.
18.
PottsJTJr. Diseases of the parathyroid gland and other hyper- and hypocalcemic disorders. In: KasperDLBraunwaldEFauciASHauserSLLongoDLJamesonJL, editors. Harrison's principles of internal medicine. 16th ed.New York: McGraw Hill; 2005:2249–68.
19.
JordanKGTelepakRJSpaethJ. Detection of hypervascular brown tumors on three-phase bone scan. J Nucl Med1993;34:2188–90.
20.
KarsentyGVigneronNJorgettiVFauchetMZingraffJDruekeT. Value of the 99mTc-methylene diphosphonate bone scan in renal osteodystrophy. Kidney Int1986;29:1058–65.
21.
McKieSBrittendenJ. Basic science: Magnetic resonance imaging. Curr Orthop2005;19:13–9.
22.
LiuJKBrockmeyerDLDaileyATSchmidtMH. Surgical management of aneurysmal bone cysts of the spine. Neurosurg Focus2003;15:1–7.
23.
ArabiAKhouryNZahedLBirbariAEl-Hajj FuleihanG. Regression of skeletal manifestations of hyperparathyroidism with oral vitamin D. J Clin Endocrinol Metab2006;91:2480–3.
24.
National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis2003;42(4Suppl 3):S1–201.
25.
BrownAJSlatopolskyE. Drug insight: Vitamin D analogs in the treatment of secondary hyperparathyroidism in patients with chronic kidney disease. Nat Clin Pract Endocrinol Metab2007;3:134–44.
26.
OgataHKoiwaFItoHKinugasaE. Therapeutic strategies for secondary hyperparathyroidism in dialysis patients. Ther Apher Dial2006;10:355–63.
27.
WeigelRJ. Nonoperative management of hyperparathyroidism: Present and future. Curr Opin Oncol2001;13:33–8.
28.
BlockGAMartinKJde FranciscoALTurnerSAAvramMMSuranyiMG. Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis. N Engl J Med2004;350:1516–25.
29.
AgarwalGMishraSKKarDKSinghAKAryaVGuptaSK. Recovery pattern of patients with osteitis fibrosa cystica in primary hyperparathyroidism after successful parathyroidectomy. Surgery2002;132:1075–85.
30.
SlatopolskyEGonzalezEMartinK. Pathogenesis and treatment of renal osteodystrophy. Blood Purif2003;21:318–26.
