Hyperparathyroidism

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Hyperparathyroidism

• overactivitiy of the parathroid gland
• PTH strong osteoclastic hormone
• Primary
• parathyroid gland adenoma
• Secondary
• chronic renal disease
• Hemodialysis (endstage renal glomerular disease)
• aka renal osteodystrophy

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Primary HPT

• most common type
• mc cause of hypercalcemia
• parathyroid adenoma 90)
• carcinoma, hyperplasia, ectopic PTH producing
  tumors
• elevated parathormone levels, hypercalcemia,
  hypophosphatemia

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Secondary HPT

• complication of chronic renal disease
• persist loss of calcium and phosphorus
• stimulates PTH release (high PTH and low to
  normal calcium)
• Hyperphosphatemia (kidneys cant excrete it as
  well)
• Tertiary HPT is seen in dialysis patients,
  parathryoid gland acts independent of serum
  calcium levels (high PTH and Calcium)
• Radiographic DDx of types is difficult

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• 30-50 women gt men
• bone pain, fractures, weakness, lethargy,
  polydipsia, polyuria
• Hypercalcemia leads to muscle weakness, hypotonia
• may have renal stones
• pancreatitis
• hypercalcemia in primary, normal to low in
  secondary
• elevated alkaline phosphatase
• elevated PTH

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stones, bones, abdominal groans and psychiatric
moans (renal stones, peptic ulcers, pancreatitis,
confusion, lethargy, weakness)
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Parathormone physiology

• maintains the circulating level of calcium ion
• stimulates osteoclasts, which reabsorb bone and
  release calcium and phosphorus ion into the blood
  stream
• increase calcium absorption through the small
  intestine
• renal tubular phosphate excretion and calcium
  absorption upsets homeostasis
• in secondary HPT calcium loss and abnormal Vit D
  formation leads to hypocalcemia and release of PTH

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Radiography - HPT

• Osteopenia
• Subperiosteal resorption (diagnostic)
• Distal tuft resorption
• Accentuated trabeculation
• Brown tumors (cystic accumulations of fibrous
  tissue)
• Loss of cortical definition
• Soft tissue calcification
• Metastatic calcification eg., vascular
  calcification

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Subperiosteal resorption

• most definitive radiographic sign of HPT
• esp at the radial margins middle and proximal
  phalanges of the 2nd and 3rd digits
• outer cortical erosion may appear frayed or lace
  like
• widened joint spaces and osteolysis, esp AC and
  SI joints

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Rugger Jersey spine
Sub-endplate sclerosis
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Salt and Pepper Skull
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Subchondral resorption
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Pre and Post treatment
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Renal osteodystrophy
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Undifferentiated seronegative spondyloarthropathy
(history, clinical presentation and what is the
most likely