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| Year : 2016 | Volume
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| Issue : 4 | Page : 822 |
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| Authors' reply |
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Doaa M Youssef
Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Click here for correspondence address and email
| Date of Web Publication | 5-Jul-2016 |
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How to cite this article:
Youssef DM. Authors' reply. Saudi J Kidney Dis Transpl 2016;27:822 |
To the Editor ,
First, the letter mentioned that bone biopsy remains the "gold standard" diagnostic tool for various osseous lesions in ROD, including brown tumor. The author wondered why we did not attempt initially to perform a biopsy of the mandibular mass to hasten early diagnosis.
Performing bone biopsy is not always necessary to make a diagnosis of ROD in most situations in clinical practice and the treatment of brown tumor is mainly pharmalogic by treating the underlying HPT. [1]
Second, regarding parathyroidectomy, this has been found to stop maladaptive PTH stimulation. The level of intact parathormone (iPTH) in our patient was 602 pg/mL, serum calcium was 9.7 mg/dL, and phosphorus was 5 mg/dL. The Vitamin D level was low at 13 ng/mL and a medical trial of intensive course of intravenous active Vitamin D for three months until the iPTH was reduced to 52 pg/mL was attempted and medical therapy is often effective for the control of hyperparathyroidism (HPT). In general, it is felt that surgical parathyroidectomy is indicated only in the presence of severe HPT associated with hypercalcemia, which precludes further treatment with medical therapy, and/or hyperphosphatemia which also may preclude medical therapy with Vitamin D sterols. [2]
 References | |  |
| 1. | KDOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Kidney Disease Outcome Quality Initiative. Am J Kidney Dis 2002;39 Suppl 1:S1-246.  |
| 2. | Jakubowski JM, Velez I, McClure SA. Brown tumor as a result of hyperparathyroidism in an end-stage renal disease patient. Case Rep Radiol 2011;2011:415476. [ PUBMED] |
Correspondence Address:
Doaa M Youssef
Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig
Egypt
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DOI: 10.4103/1319-2442.185281 PMID: 27424708 
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