Unmasking the Archnemesis: Primary Hyperparathyroidism Presenting As Brown Tumors of the Jaws

Brown tumor (BT), particularly of the jaws, is a rare and late manifestation of primary hyperparathyroidism (PHPT), a disease most commonly reported in middle-aged women. It is usually attributed to adenoma (single or multiple), hyperplasia of the parathyroid gland, and rarely carcinoma. A generalized loss of lamina dura, although a late manifestation, is most commonly attributed to PHPT. The routine use of orthopantomograms (OPG) in dentistry makes the dentist one of the frontrunners in diagnosing this disease. Here we report the case of a 42-year-old female who presented to our clinic with the complaint of swelling in the right back region of the lower jaw and loosening of teeth. OPG and cone-beam computed tomography revealed a generalized loss of lamina dura and three well-defined radiolucent regions: two in the mandible and one in the maxilla. The provisional diagnosis was giant cell lesion of hyperparathyroidism, which was further confirmed by biochemical analysis and sestamibi scan. The patient underwent left parathyroidectomy, and clinical and radiographic follow-up was done at 6 months and 12 months after surgery. Our patient had a single adenoma on her left parathyroid gland, leading to primary hyperparathyroidism, which only presented with oral symptoms. This case highlights the importance of dentists in diagnosing such endocrinopathies that may present with mere oral manifestations.