Radiographic features of oral manifestations of secondary hyperparathyroidism with cranial involvement: a rare case report

I Nyoman Guswan; Menik Priaminiarti; Inka Saraswati; Vera Julia

doi:10.32793/jrdi.v10i1.1432

Authors

I Nyoman Guswan Resident in Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia, 10430, Indonesia
Menik Priaminiarti Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia, 10430, Indonesia
Inka Saraswati Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia, 10430, Indonesia
Vera Julia Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia, 10430, Indonesia

DOI:

https://doi.org/10.32793/jrdi.v10i1.1432

Keywords:

Secondary hyperparathyroidism, oral manifestation, ground-glass appearance, panoramic radiograph, MDCT

Abstract

Objectives: This case report aims to present a rare case of radiographic oral manifestations of secondary hyperparathyroidism associated with chronic kidney disease.

Case Report: A 32-year-old female patient came to Universitas Indonesia Hospital with a chief complaint of gradual swelling in her oral cavity for approximately 1 year. Clinical examination revealed swelling in the gum and palate of the upper jaw, the swelling increasing in size, causing difficulty in speaking and eating. There is also face deformity along with the increasing size of the swelling. The panoramic radiograph and MDCT showed thinning of cortical bone, absence of lamina dura, and ground-glass appearance in the dentomaxillofacial area, including several parts of the skull, which is consistent with characteristics of oral manifestations of secondary hyperparathyroidism (HPT).

Conclusion: A rare case of secondary HPT associated with chronic renal illness that manifests with panoramic radiograph, MDCT, and oral characteristics is presented.

References

1. Aerden T, Grisar K, Nys M, Politis C. Secondary hyperparathyroidism causing increased jaw bone density and mandibular pain: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2018;125(3):e37–e41 https://doi.org/10.1016/j.oooo.2017.11.020

2. Kakade SP, Gogri AA, Umarji HR, Kadam SG. Oral manifestations of secondary hyperparathyroidism: A case report. Contemp Clin Dent 2015;6(4):552–558. https://doi.org/10.4103/0976-237X.169840

3. Guimarães LM, Valeriano AT, Pontes HAR, Gomez RS, Gomes CC. Manifestations of hyperparathyroidism in the jaws: Concepts, mechanisms, and clinical aspects. Oral Surg Oral Med Oral Pathol Oral Radiol 2022;133(5):547–555.

4. Bennett J, Suliburk JW, Morón FE. Osseous manifestations of primary hyperparathyroidism: Imaging findings. Int J Endocrinol 2020;2020:3146535 https://doi.org/10.1155/2020/3146535

5. Wood NK, Goaz PW. Differential diagnosis of oral and maxillofacial lesions. 5th ed. St. Louis: Mosby; 1997. p.393–396.

6. Kaiser W, Schmidt GA, Gerlach H. Quintärer Hyperparathyreoidismus. Z Gesamte Inn Med 1976;31(11):358–364.

7. Jha V, García-García G, Iseki K, et al. Chronic kidney disease: Global dimension and perspectives. Lancet 2013;382:260–272.

8. Tsai SH, Kan WC, Jhen RN, Chang YM, Kao JL, Lai HY, Liou HH, Shiao CC. Secondary hyperparathyroidism in chronic kidney disease: A narrative review focus on therapeutic strategy. Clin Med 2024;24(5):100238 https://doi.org/10.1016/j.clinme.2024.100238

9. Lau WL, Obi Y, Kalantar-Zadeh K. Parathyroidectomy in the management of secondary hyperparathyroidism. Clin J Am Soc Nephrol 2018;13(6):952–961. https://doi.org/10.2215/CJN.10390917

10. Bartter FC. Bone as a target organ: Toward a better definition of osteoporosis. Perspect Biol Med 1973;16:215–231 https://doi.org/10.1353/pbm.1973.0028

11. Muppidi V, Meegada SR, Rehman A. Secondary hyperparathyroidism. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023

12. Bratucu MN, Garofil ND, Radu PA, Paic V, Goleanu V, Zurzu M, Popa F, Strambu V, Straja DN. Measurement of quality of life after total parathyroidectomy in patients with secondary hyperparathyroidism and end stage renal disease. Chirurgia 2015;110(6):511–517.

13. Kovesdy CP. Epidemiology of chronic kidney disease: An update 2022. Kidney Int Suppl 2022;12(1):7–11 https://doi.org/10.1016/j.kisu.2021.11.003

14. Chang CY, Rosenthal DI, Mitchell DM, Handa A, Kattapuram SV, Huang AJ. Imaging findings of metabolic bone disease. Radiographics 2016;36(6):1871–1887 https://doi.org/10.1148/rg.2016160004

15. Chertow GM, Pupim LB, Block GA, Correa-Rotter R, Drueke TB, Floege J, Goodman WG, London GM, Mahaffey KW, Moe SM, Wheeler DC, Albizem M, Olson K, Klassen P, Parfrey P. Evaluation of cinacalcet therapy to lower cardiovascular events (EVOLVE): Rationale and design overview. Clin J Am Soc Nephrol 2007;2(5):898–905.

16. Lacativa PG, Franco FM, Pimentel JR, Patrício Filho PJ, Gonçalves MD, Farias ML. Prevalence of radiological findings among cases of severe secondary hyperparathyroidism. São Paulo Med J 2009;127(2):71–77 https://doi.org/10.1590/s1516-31802009000200004

17. Fliefel R. Systematic review of oral manifestations related to hyperparathyroidism. Clin Oral Investig 2017 https://doi.org/10.1007/S00784-017-2124-0

18. Padbury AD, Tözüm TF, Taba M, et al. The impact of primary hyperparathyroidism on the oral cavity. J Clin Endocrinol Metab 2006;91:3439–3445.

19. García-Rueda S, Márquez-Arrico CF, Herrero-Babiloni A, Silvestre-Rangil J, Silvestre FJ. Influence of normocalcemic primary hyperparathyroidism in bone density alterations of the jaws in patients with periodontitis. Med Oral Patol Oral Cir Bucal 2025;30(1):e151–e159 https://doi.org/10.4317/medoral.26958

20. Albagieh H, Alosimi A, Aldhuhayan A, AlAbdulkarim A, Fatani B, Alabood A. Dental management of patients with renal diseases or undergoing renal transplant. Saudi Dent J 2024;36(2):270–276 https://doi.org/10.1016/j.sdentj.2023.11.023

21. Khalekar Y, Zope A, Brahmankar U, Chaudhari L. Hyperparathyroidism in dentistry: Issues and challenges!!. Indian J Endocrinol Metab 2016;20(4):581–582. https://doi.org/10.4103/2230-8210.183452

22. Silva-Gutiérrez VM, Macías-Jiménez JB, Molotla-Fragoso A, Mejía-Velázquez CP, Estévez-González GL, Jacinto-Alemán LF. Brown tumor in jaw associated with hyperparathyroidism: A case report. Oral 2025;5(3):59 https://doi.org/10.3390/oral5030059