Radiology of HyperParaThyroidism

- Findings:
    - Assymmetrical osteopenia;
    - Spine: vertebral compression fractures;
    - Skull:
         - so-called salt-and-pepper skull
         - tiny punched out lesions may be present in the skull, producing so called salt and pepper appearance;
    - Clavicle: erosion of the outer centimeter of the clavicle
    - Tibia: marked osteopenia of the medial aspect of the tibia
    - Phalanges:
         - subperiosteal resorption of digital tufts and phalanges (which is usually more marked on radial than on
                  ulnar side of the hand);
         - look for resorption of phalangeal tufts and replacement of usually sharp cortical outline of bone in digits
                  by irregular outline (subperiosteal resorption);
         - ref: Images in Clinical Medicine. Subperiosteal Bone Resorption

- Brown Tumors:

     - occurs in severe cases;
     - referred to as "Giant Cell Tumor of Diaphysis"
     - microscopical exam revealed that it was composed of numerous osteoclasts with stromal hemorrhage;
     - ref: A case of multiple skeletal lesions of brown tumors, mimicking carcinoma metastases

- Soft Tissues Calcification: (see: diff dx)
     - occurs due to increase in serum calcium & serum phosphate (seen in secondary HPT);
     - special sites of affinity for calcification include triangular ligament in the distal radio-ulnar articulation, menisci, and
              articular cartilages;
     - chondrocalcinosis can be seen by itself in elderly and has been associated with chronic disorders such as osteoarthritis,
              rheumatoid arthritis, diabetes mellitus, hypertension, hyperthyroidism, acromegaly, and Paget's disease;

- Bone:
    - mobilizes bone and phosphate;
    - releases osteocytic perilacunaar stores (fast)
    - increases osteocytic number and activity (slow)
    - activating and increasing number of osteoclasts, which destroys hydroxyapatite, thus releasing calcium and phosphate

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, December 1, 2016 10:10 am