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
Primary HPT
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most common type
mc cause of hypercalcemia
parathyroid adenoma 90%)
carcinoma, hyperplasia, ectopic PTH
producing tumors
• elevated parathormone levels,
hypercalcemia, hypophosphatemia
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 can’t 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
• 30-50 women > 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
stones, bones, abdominal groans and psychiatric moans
(renal stones, peptic ulcers, pancreatitis, confusion,
lethargy, weakness)
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
Radiography - HPT
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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
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
Rugger Jersey spine
Sub-endplate sclerosis
Salt and Pepper Skull
Subchondral resorption
Pre and Post treatment
Renal osteodystrophy
Undifferentiated seronegative spondyloarthropathy (history,
clinical presentation and what is the most likely
Sacroiliitis
HLA -B27
Positive HLA-B27
Negative HLA-B27
Undifferentiated
HPT
(Calcium levels)
AS*
Gout
(uric acid levels)
Enteropathic
DJD
Psoriatic
Infection
(unilateral)
Reiter’s
Reactive arthritis
Trauma
Pregnancy
DISH
(upper third)
OCI