Acute neurological syndrome complicating secondary hyperparathyroidism.

Longstanding severe hyperparathyroidism can lead to the formation of "brown tumors," benign but locally aggressive neoplasms. We present the case of a young woman with end-stage renal disease on hemodialysis with uncontrolled secondary hyperparathyroidism. The patient presented with progressive lower extremity weakness and back pain. Imaging showed multiple lytic bone lesions, the most impressive being a T3 spinal lesion causing cord compression. She underwent urgent neurosurgical resection of the tumor at T3 followed by subtotal parathyroidectomy. Our case touches upon the pathophysiology, consequences, and treatment of secondary hyperparathyroidism in patients with end-stage renal disease.