Brown tumor involving the sellar-parasellar region mimicking pituitary adenoma as the tip of the iceberg of generalized primary hyperparathyroidism

The authors present a case study of a 40-year-old man with advanced, previously undiagnosed primary hyperparathyroidism (PHPT), which first manifestation directing to correct diagnosis was sellar-parasellar brown tumor. Further studies disclosed PHPT. The patient presented many of the classic signs of the disease, including renal stones, duodenal ulcer, muscle weakness and bone pains, but suspicion of PHPT was made on the base of a postoperative histological examination of the sellar- parasellar tumor. Laboratory investigations showed hypercalcaemia, hypophosphataemia, elevated levels of parathyroid hormone and alkaline phosphatase. A skeletal survey showed generalized decreased density of bones and multiple brown tumors. The problems of diagnosis and localization of parathyroid glands have been discussed. The literature has been reviewed and the importance of early diagnosis and treatment has been stressed.