Unmasking Primary Hyperparathyroidism: Two Rare Cases of Brown Tumors Presenting as Diagnostic Dilemma

Background: Brown tumors (BT) with an overall incidence of 2-3%, are rare but characteristic presenting features of primary hyperparathyroidism (PHPTH) which are often missed, resulting in delayed diagnosis. We present two unique cases where bony lesions were the initial presentation of BT, ultimately unravelling PHPTH. Method: First case involves a 43 year male presenting with repeated femur fractures, generalized fatigue and bony pain with Bone scan suggesting Metabolic bone disease. Second case was of a 36 year male presenting with painful deformity at left humerus fracture site. Result: Both cases on histopathology were reported as Brown tumor, with subsequent work up revealing metabolic derangements and Parathyroid adenoma in each. Conclusion: This report highlights that fractures can mask rare osteolytic lesions like BT, which may serve as the first clue to PHPTH. Histopathological evaluation of debrided tissue becomes crucial to catch the lesion early as it is gold standard for diagnosis complemented with a multidisciplinary approach.