Nickan Research Institute Journal of Renal Injury Prevention 2345-2781 7 4 2018 12 01 Leontiasis ossea; a rare presentation of secondary hyperparathyroidism 321 323 10.15171/jrip.2018.69 EN Hoda Raffiei Jelodar Maliheh Yarmohamadi Massoud Baghai Wadji Mohammad Reza Babaei Journal Article 10.15171/jrip.2018.69 2018 03 08 2018 07 20 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.