Submit Manuscript | http://medcraveonline.com Introduction The brown tumor is a benign tumor, which affects patients with hyperparathyroidism. These lesions are rare and occur in 4.5% of cases of primary hyperparathyroidism (HPT) 1 and related to a parathyroid adenoma in 81% of cases. 2 Primary hyperparathyroidism is a common disease, especially in post menopauses women, rarely in men. 3 We describe a case of a parathyroid adenoma diagnosed after a Tc 99m methylene diphosphonate (MDP) whole body bone scan showing the aspect of multiple brown tumors mimicking bone metastases. Case report A 64-year-old man, without signifcant medical history, presented with multiple bone pain.These pains were not calmed by analgesics. The general condition was maintained and physical examination was normal. There were no clinical signs of Hypercalcemia (polyuria, gastrointestinal symptoms). Biology showed calcium at upper limit level: 2.66mmol/l (the reference range for the laboratory was 2.2-2.6mmol/l). We did X-rays analyses and a CT-scan that showed multiple lytic lesions especially on peripheral bones (Figure 1). Secondary bone metastases were suspected therefore bone scintigraphy was indicated. He did a Tc-99m MDP whole body bone scan which showed multiple areas of intense uptake, within both axial and peripheral skeleton, on the same sites of lytic lesions found on X-rays analyses and CT-scan (Figure 2). That aspect recalls the aspect of disseminated brown tumors, so we dosed the PTH in serum, which was very high: 2003µg/l (the reference range for the laboratory was11-62µg/l). The diagnosis of parathyroid adenoma was highly suspected. The patient was then referred for dabble phase parathyroid scintigraphy. Planar images and hybrid single-photon emission computed tomography-computed tomography (SPECT/CT) was performed after intravenous injection of 555MBq of 99mTc-sestamibi. Planar images showed a large area of pathological uptake of the radiotracer projecting below the lower pole of the left thyroid lobe suggesting an abnormal parathyroid and did not fnd mediastinal or cervical ectopic gland (Figure 3). The cervico-thoracic SPECT/CT and the fused images beside confrm and localize the left inferior parathyroid adenoma and shows left scapula, right humerus and costal osteolytic lesions (Figure 4). The patient was sent to ORL for surgery. Histology confrmed a parathyroid adenoma. PTH levels decreased considerably after surgery. Figure 1 X-rays analyses showing lytic lesions on peripheral bones. Endocrinol Metab Int J. 2017;4(1):1‒2. 1 © 2017 Yeddes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Disseminated bone pain related to brown tumors revealing a parathyroid adenoma: a case report Volume 4 Issue 1 - 2017 Yeddes I, Meddeb I, Limam Kaouther, Somaii M, Mhiri A, Slim I, Ben Slimene MF Faculty of Medicine of Tunis, University Tunis El Manar, Salah Azaiez Institute, Tunisia Correspondence: Imene Yeddes, Faculty of medicine of Tunis, Salah Azaiez Institute, Tunis El Manar University, 15 Rue Djebel Lakhdhar, La Rabta, 1007, Tunis, Tunisia, Tel: 002695539008; Email Received: November 10, 2016 | Published: December 19, 2016 Abstract Introduction: Primary hyperparathyroidism is a common disease especially in women but rarely discovered by multiple brown tumors with near normal serum calcium. Case report: A 64-year-old man presented with disseminated bone pain. He had X-rays and a CT scan that objectifed lytic lesions. These lesions correspond to multiple areas of intense uptake in bone scan evoking brown tumors. Biology showed calcium at 2.66mmol/l and PTH in serum at 2003µg/l. The diagnosis of parathyroid adenoma was highly suspected that’s why we did a Tc 99m sestamibi dabble phase parathyroid scan. It showed a left inferior parathyroid adenoma. Conclusion: The scintigraphic imaging is a valuable contribution to the diagnosis of brown tumor, it also allows for the etiologic diagnosis by detecting the nodule parathyroid. Keywords: hyperparathyroidism, brown tumour, bone scan, parathyroid adenoma, hypercalcemia, parathyroid hormone, methylene diphosphonate, costal osteolytic lesions Endocrinology & Metabolism International Journal Case Report Open Access