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Hyperparathyroidism
Radiographic features
1. subperiosteal bone resorption
classically affects the radial aspects of the proximal and middle phalanges of the 2nd and 3rd fingers
medial aspect of tibia, femur, humerus
lamina dura: floating teeth (not specific)
2.subchondral resorption
lateral end of the clavicles
symphysis pubis
sacroiliac joints
3.subligamentous resorption
ischial tuberosity
trochanters
inferior surface of calcaneus and clavicle
4.intracortical resorption: cigar/oval-shaped or tunnel-shaped radiolucency in the cortex
5.terminal tuft erosion (acro-osteolysis)
6.rugger jersey spine
7.osteopenia
8.brown tumours
9.salt and pepper sign in the skull (pepper pot skull)
10.chondrocalcinosis
Secondary hyperparathyroidism
Findings in secondary (and tertiary) hyperparathyroidism are often associated with the osteosclerosis of renal osteodystrophy and the osteomalacia of vitamin D deficiency:
subperiosteal bone resorption
osteopenia
osteosclerosis, e.g. rugger jersey spine
soft tissue calcification
superscan: generalised increased uptake on Tc-99m pertechnetate bone scan (focal uptake with adenoma)
superior and inferior rib notching
Subtypes of Hyperparathyroidism
primary hyperparathyroidism
parathyroid adenoma (~80%)
multiple parathyroid adenomas (4%) 5
parathyroid hyperplasia (10-15%) 2,5
parathyroid carcinoma (1-5%) 4,5
parathyromatosis (very rare)
secondary hyperparathyroidism
caused by chronic hypocalcaemia with renal osteodystrophy being the most common cause (others include malnutrition, vitamin D deficiency) 4
results in parathyroid hyperplasia 7
tertiary hyperparathyroidism
autonomous parathyroid adenoma caused by the chronic overstimulation of hyperplastic glands in renal insufficiency
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