Evidence Based Solving Approach in Diagnosis of Primary Hyperparathyroidism with Oral Manifestations: Report of Three Unusual Cases
A 38-year-old female complained of swelling in anterior maxillary region since 2 months. She gave history of swelling in mandibular right posterior region 3 years back which was diagnosed as central giant cell granuloma and removed surgically. Two months later left posterior teeth were extracted due to mobility. No significant contributory medical history was there. Intraoral examination revealed a firm, nontender, nonpulsatile swelling extending from 23 to 26 with displacement of 23, 24, and 25 with grade 1 mobility [; inset]. Patient was known case of hypertension since 2 years.\nRadiographic examination revealed a soft tissue mass causing resorption of left posterior maxillary alveolar region with displacement of 23 and 24. Multiple, radiolucent, cyst-like lesions involving whole of the body of mandible and thinning of inferior border of mandible was observed as incidental finding []. CT scan was also performed which revealed osteolytic lesions in the whole body of mandible.\nThese clinicoradiographic findings raised the suspicion of HPT. So further investigations in the form of radiographic skeletal survey, biochemical tests [], fine needle aspiration cytology histopathology, and nuclear imaging was carried out in all the three cases.\nThe patients were thereafter subjected to incisional biopsy and histopathologic examination revealed numerous capillaries and yellowish brown pigmentation due to hemosiderin deposition along with innumerable multinucleated giant cells []. Based on these clinicoradiographic, histopathological and biochemical evidences confirmative diagnosis of HPT was given. All patients were treated surgically followed by medicinal therapy. Regular follow up of patients were done with significant improvement without any reported recurrence.