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.