Localization of Brown Tumors With F-18-Fluorocholine PET/CT Imaging in Severe Primary Hyperparathyroidism

We present the case of a 68-year-old woman with a painful tibial tumor and fatigue. Histology and laboratory studies were consistent with a brown tumor secondary to initially unrecognized, severe primary hyperparathyroidism. F-18-fluorocholine PET/CT revealed a large hypermetabolic parathyroid mass and multiple bone foci considered as brown tumors. Unilateral neck exploration confirmed a large parathyroid adenoma. Serum calcium and parathyroid hormone levels normalized quickly, and symptoms subsided gradually after parathyroidectomy. Brown tumors are a rare complication of severe hyperparathyroidism. F-18-fluorocholine PET/CT allows the localization of parathyroid adenomas and brown tumors, and can be used as a single imaging modality.

Automated summary

We report a case of a 68-year-old woman with a tibial tumor and fatigue, which was diagnosed as a brown tumor secondary to severe primary hyperparathyroidism. F-18-fluorocholine PET/CT was used to localize the parathyroid adenoma and brown tumors, which were confirmed by unilateral neck exploration. After parathyroidectomy, the patient's symptoms improved with normalization of serum calcium and parathyroid hormone levels.