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      Mandibular Brown Tumor as a Result of Secondary Hyperparathyroidism: A Case Report with 5 Years Follow-Up and Review of the Literature

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          Abstract

          Background: Brown tumor is a rare skeletal manifestation of secondary hyperparathyroidism. Although diagnosis of the disease is increasingly seen in early stages due to improved screening techniques, some patients still present in a progressed disease stage. The treatment depends on tumor mass and varies from a conservative approach with supportive parathyroidectomy to extensive surgical resection with subsequent reconstruction. Case presentation: We report a case of extensive mandibular brown tumor in a patient with a history of systemic lupus erythematosus, chronic kidney disease, and secondary hyperparathyroidism. Following radical resection of the affected bone, reconstruction could be successfully performed using a free flap. Conclusions: There were no signs of recurrence during five years of close follow-up. Increased awareness and multidisciplinary follow-ups could allow early diagnosis and prevent the need for radical therapeutical approaches.

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          Most cited references34

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          Primary hyperparathyroidism

          Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by hypercalcaemia and elevated or inappropriately normal serum levels of parathyroid hormone. Here, Walker and Silverberg review the pathogenesis, diagnosis and management of PHPT, focusing on recent advances in the field.
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            Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options.

            Secondary hyperparathyroidism (SHPT) is a challenge frequently encountered in the management of patients with chronic kidney disease (CKD). Downregulation of the parathyroid vitamin D and calcium-sensing receptors represent critical steps that lead to abnormalities in mineral metabolism: high phosphate, low calcium, and vitamin D deficiency. These imbalances result in parathyroid hyperplasia and contribute to vascular calcification. New studies have established a central role for fibroblast growth factor 23 (FGF-23) in the regulation of phosphate-vitamin D homeostasis. FGF-23 concentration increases in CKD and contributes to SHPT. Achieving current targets for the key mineral parameters in the management of SHPT set by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines can be challenging. This review summarizes the current understanding and evidence supporting strategies for SHPT treatment in CKD patients. Treatment should include a combination of dietary phosphorus restriction, phosphate binders, vitamin D sterols, and calcimimetics. Parathyroidectomy is effective in suitable candidates refractory to medical therapy and the standard against which new approaches should be measured. Future strategies may focus on the stimulation of apoptotic activity of hyperplastic parathyroid cells. © 2011 by the American Society of Nephrology
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              Mandibular Reconstruction: Overview.

              Mandibular reconstruction has changed significantly over the years and continues to evolve with the introduction of newer technologies and techniques.
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                Author and article information

                Contributors
                Role: Academic Editor
                Role: Academic Editor
                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                09 July 2021
                July 2021
                : 18
                : 14
                : 7370
                Affiliations
                [1 ]Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; Frederic.Weichel@ 123456med.uni-heidelberg.de (F.W.); andr.vollmer@ 123456gmail.com (A.V.); Michael.Vollmer@ 123456med.uni-heidelberg.de (M.V.); christian.freudlsperger@ 123456med.uni-heidelberg.de (C.F.); christian.mertens@ 123456med.uni-heidelberg.de (C.M.); Juergen.Hoffmann@ 123456med.uni-heidelberg.de (J.H.)
                [2 ]Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany; benjamin.goeppert@ 123456med.uni-heidelberg.de (B.G.); Matthias.Gaida@ 123456unimedizin-mainz.de (M.M.G.)
                [3 ]Institute of Pathology, University Medical Center Mainz, Johannes Gutenberg-Universität Mainz, 55131 Mainz, Germany
                [4 ]Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; babak.saravi@ 123456jupiter.uni-freiburg.de
                Author notes
                Author information
                https://orcid.org/0000-0003-2298-3696
                https://orcid.org/0000-0002-0222-7060
                https://orcid.org/0000-0002-4289-0457
                https://orcid.org/0000-0002-6305-364X
                https://orcid.org/0000-0002-1322-755X
                Article
                ijerph-18-07370
                10.3390/ijerph18147370
                8304219
                34299820
                067e3a37-1bf5-48cb-8f1a-c938f7e30b86
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 10 June 2021
                : 05 July 2021
                Categories
                Case Report

                Public health
                brown tumor,secondary hyperparathyroidism,jaw,radical resection,microvascular reconstruction

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