Abstract: TH-PO0244
Brown Tumors in Dialysis: A Diagnostic Dilemma
Session Information
- Bone and Mineral Metabolism: Clinical Reports and Practice
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Shirsat, Pallavi D., Minden Medical Center, Minden, Louisiana, United States
- Sonavane, Kunal, Willis Knighton Bossier, Bossier City, Louisiana, United States
Introduction
Brown tumors are rare benign osteolytic lesions resulting from prolonged, uncontrolled hyperparathyroidism; often seen in patients with end stage renal disease (ESRD) on dialysis. They may mimic malignancy; particularly when presenting as severe pain with multiple lytic lesions on imaging, posing a diagnostic challenge.
Case Description
A 73-year-old female with ESRD due to hypertensive nephrosclerosis on hemodialysis (HD) for 18 years presented with progressively worsening lower back pain, leading to poor HD compliance. Pain was exacerbated by prolonged sitting during HD sessions. She was anuric and denied gait instability, bowel issues, trauma, weight loss or systemic symptoms. Neurologic exam showed mild lower extremity weakness without sensory loss. Non-contrast CT of lumbar spine revealed lucent lesions in vertebrae, sacrum and hips (Fig 1) raising concerns for multiple myeloma or metastasis. Labs showed elevated iPTH 2542 pg/mL, calcium 9.1 mg/dL, phosphorus 5.5 mg/dL and elevated alkaline phosphatase 261 U/L. Serum electrophoresis was negative. Bone marrow biopsy showed no malignancy; Immunohistochemistry showed normal plasma cells. Flow cytometry found no abnormal cells. A diagnosis of brown tumors was thus made.
The patient was started on intensified secondary hyperparathyroidism (SHPT) therapy, including phosphate binders, calcimimetics, and calcitriol. Parathyroidectomy was deferred due to high operative risk; medical therapy was continued. She remains non-complaint with calcimimetics due to GI side effects but shows improved adherence to other medications.
Discussion
This case emphasizes considering brown tumors in ESRD patients with lytic lesions and SHPT. Misdiagnosis as malignancy can delay appropriate treatment. Besides multidisciplinary approach, early recognition and treatment of SHPT is critical to prevent skeletal complications such as brown tumors.
CT image showing lytic lesions