eISSN: 2345-2781  
Submitted: 08 Mar 2018

Accepted: 20 Jul 2018
First published online: 09 Aug 2018
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J Renal Inj Prev. 2018;7(4):321-323.
doi: 10.15171/jrip.2018.69

Case Report

Leontiasis ossea; a rare presentation of secondary hyperparathyroidism

Hoda Raffiei Jelodar 1, Maliheh Yarmohamadi 1 * , Massoud Baghai Wadji 3, Mohammad Reza Babaei 4

1 Shahid Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
2 Department of Internal Medicine, Kousar Hospital, Semnan University of Medical Sciences, Semnan, Iran
3 Department of Surgery, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
4 Department of Interventional Radiology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
*Corresponding author: Malihe Yarmohamadi, Email: Email: malihehyarmohamadi @ yahoo.com


Leontiasis ossea is a rare presentation of renal osteodystrophy with few reports in literature. It causes severe skeletal deformity in the cranial bones. This study presents a report on a patient with advanced hyperparathyroidism with skeletal changes compatible with leontiasis ossea. The patient was a 34-year-old man with end-stage renal disease, uncontrolled hypertension, and dyspnea who was referred to our hospital. Physical examinations revealed: toggled speech (nasal speech), mouth breathing and facial change, saddle nose, nares widening, increased interdental space and mandibular enlargement. His serum intact parathyroid hormone (iPTH) level was 3199 pg/mL, Paranasal sinuses CT scan showed a significant expansion of the mandibular, maxillary and skull bones. Parathyroid sonography reported two severe hypertrophied parathyroid glands. The patient underwent total parathyroidectomy as a result of symptomatic bone involvement.

Implication for health policy/practice/research/medical education:

Uremic leontiasis ossea (ULO) can cause life-threatening upper airway obstruction and compressive cranial neuropathy. Hence, early recognition and treatment of leontiasis ossea can prevent its complications.

Please cite this paper as: Raffiei Jelodar H, Yarmohamadi M, Baghai Wadji M, Babaei MR. Leontiasis ossea; a rare presentation of secondary hyperparathyroidism. J Renal Inj Prev. 2018;7(4):321-323. DOI: 10.15171/jrip.2018.69.

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