Kidney Week

Abstract: TH-PO172

Leontiasis Ossea in Hyperparathyroidism Secondary to Inadequate ESKD Management

Session Information

• CKD-MBD: Clinical
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 502 Bone and Mineral Metabolism: Clinical

Authors

• Garcia, Ruby, University of Nevada Reno, Reno, Nevada, United States

Ruby Garcia

• Lazcano, Greilys, University of South Florida, Tampa, Florida, United States

Greilys Lazcano, MD

• Lamarche, Jorge A., University of South Florida, Tampa, Florida, United States

Jorge A. Lamarche, MD

• Antar-Shultz, Marina, University of South Florida, Tampa, Florida, United States

Marina Antar-Shultz, DO

• Taha, Mohamed M., University of South Florida, Tampa, Florida, United States

Mohamed M. Taha, MD, FASN

• Ceka, Endri, University of South Florida, Tampa, Florida, United States

Endri Ceka, MD

• Zervogiannis, Panagiotis, University of South Florida, Tampa, Florida, United States

Panagiotis Zervogiannis, MD

Introduction

Management of PO4, Ca, and parathyroid hormone (PTH) levels is essential for proper bone health in End Stage Renal Disease (ESRD). Leontiasis ossea (LO) is a severe form of osteodystrophy characterized by skeletal growth abnormalities that occurs in ESRD with long-standing, uncontrolled overproduction of PTH. Presentation includes facial swelling and/or jaw pain. Severe cases present with facial disfigurement due to bony expansion of maxillary bones extending into the orbit, mouth, nose or sinuses. This leads to complications such as dysphagia, exophthalmos, or visual loss if compression of the optic nerve occurs.

Case Description

28 y/o undocumented M with ESRD on hemodialysis (HD) for 19 years presented with facial swelling, dysphagia, and dysarthria (Figure 1). The patient was unable to have adequate ESRD management due to financial constrains. Laboratory tests revealed a high PTH level at 5470 pg/ml. Ca++ and PO4 levels were normal. CT scan revealed bone changes consistant with LO.

Discussion

Excess PTH production, caused by ESRD, leads to increased osteoclast and osteoblast activity. There is unprecedented unmineralized bone formation and expansion in LO. LO is rare and only presents in inadequate ESRD management. There are no standardized methods to diagnose and treat LO. Preventative treatment include strict medical management of metabolic derangements with adherence to dialysis, calcimimetics, and PO4 binders. Parathyroidectomy is an alternative when medical therapy fails and has been shown to halt bone remodeling. There is no evidence to surgically remove excess bone unless is considered to improve quality of life and to treat life-threatening complications.