Single gland adenoma is the most common cause of primary hyperparathyroidism (PHPT). Although PHPT is generally an asymptomatic disease detected by an incidental Şnding of hypercalcemia, overt skeletal disease, renal failure and huge adenoma that cause local pressure can be seen seldomly in neglected cases. We report a case of a parathyroid adenoma weighing 116 g (normal weight 25 - 40 mgs) causing multiple brown tumors, renal failure and refractory anemia
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1. Bilezikian JP, Brandi ML, Rubin M, Silverberg SJ. Primary hyperparathyroidism: New concepts in clinical, densitometric and biochemical features. J Intern Med. 2005;257(1):6-17
2. Fraser WD. Hyperparathyroidism. Lancet. 2009;374(9684):145-58.
3. Palmer FJ, Nelson JC, Bacchus H. The chloride-phosphate ratio in hypercalcemia. Ann Intern Med. 1974;80(2):200-04.
4. Yao K, Singer FR, Roth SI, Sassoon A, Ye C, Giuliano AE. Weight of normal parathyroid glands in patients with parathyroid adenomas. J Clin Endocrinol Metab. 2004;89(7):3208-13.
5. Tsuchiya A, Endo S, Abe R. Giant adenoma of the parathyroid: Report of a case. Surg Today. 1993;23(5):465-7.
6. Power C, Kavanagh D, Hill AD, O'Higgins N, McDermott E. Unusual presentation of a giant parathyroid adenoma: Report of a case. Surg Today. 2005;35(3):235-7.
7. Rao DS, Agarwal G, Talpos GB, Phillips ER, Bandeira F, Mishra SK, Mithal A. Role of vitamin d and calcium nutrition in disease expression and parathyroid tumor growth in primary hyperparathyroidism: A global perspective. J Bone Miner Res. 2002;17 Suppl 2:N75-80.
8. Kaya RA, Cavusoglu H, Tanik C, Kahyaoglu O, Dilbaz S, Tuncer C, Aydin Y. Spinal cord compression caused by a brown tumor at the cervicothoracic junction. Spine J. 2007;7(6):728-32.
9. Altan L, Kurtoglu Z, Yalcinkaya U, Aydinli U, Erturk E. Brown tumor of the sacral spine in a patient with low-back pain. Rheumatol Int. 2007;28(1):77-81. 10. Peacock M. Primary hyperparathyroidism and the kidney: Biochemical and clinical spectrum. J Bone Miner Res. 2002;17 Suppl 2:N87-94.
11. Mizumoto D, Watanabe Y, Fukuzawa Y, Aoi N, Yamazaki C. Clinical profile and outcome of primary hyperparathyroidism accompanied by chronic renal failure. Clin Nephrol. 1994;42(5):315-21.
12. Jimbo-Saito R, Ubara Y, Kadoguchi H, Suwabe T, Nakanishi S, Higa Y, Hoshino J, Sawa N, Katori H, Takemoto F, Nishimura H, Nakamura M, Tomikawa S, Ohashi K, Takaichi K. A case of primary hyperparathyroidism with severe bone and renal changes. J Bone Miner Metab. 2009;27(6):727-32.