Hyperparathyroidism

Changed by Yuranga Weerakkody, 1 Jun 2020

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Hyperparathyroidism is the effect of excess parathyroid hormone in the body. It can be primary, secondary, or tertiary. There are many characteristic imaging features, predominantly involving the skeletal system.

Pathology

Increased levels of the parathyroid hormone lead to increased osteoclastic activity. The resultant bone resorption produces cortical thinning (subperiosteal resorption) and osteopenia.

Subtypes

primary hyperparathyroidism
- parathyroid adenoma (~80%)
  - multiple parathyroid adenomas (4%) ⁵
- parathyroid hyperplasia (10-15%) ^2,5
- parathyroid carcinoma (1-5%) ^4,5
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
tertiary hyperparathyroidism
- autonomous parathyroid adenoma caused by the chronic overstimulation of hyperplastic glands in renal insufficiency

Associations

Hyperparathyroidism can occur in the context of the following conditions from parathyroid hyperplasia or less commonly multiple parathyroid adenomas ⁵:

Radiographic features

subperiosteal bone resorption
- classically affects the radial aspects of the proximal and middle phalanges of the 2^nd and 3^rdfingers
- medial aspect of tibia, femur, humerus
- lamina dura: floating teeth (not specific)
subchondral resorption
subligamentous resorption
- ischial tuberosity
- trochanters
- inferior surface of calcaneus and clavicle
intracortical resorption: cigar/oval-shaped or tunnel-shaped radiolucency in the cortex
terminal tuft erosion (acro-osteolysis)
rugger jersey spine
osteopenia
brown tumours
salt and pepper sign in the skull (pepper pot skull)
chondrocalcinosis

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

~~-<li>familial hypocalciuric hypercalcaemia</li>~~
~~-<li>familial isolated primary hyperparathyroidism</li>~~
+<li><a title="familial hypocalciuric hypercalcaemia" href="/articles/familial-hypocalciuric-hypercalcaemia">familial hypocalciuric hypercalcaemia</a></li>
+<li><a title="familial isolated primary hyperparathyroidism" href="/articles/familial-isolated-primary-hyperparathyroidism">familial isolated primary hyperparathyroidism</a></li>
~~-<a href="/articles/osteosclerosis">osteosclerosis</a>, e.g. <a href="/articles/rugger-jersey-spine-hyperparathyroidism">rugger-jersey spine</a>~~
+<a href="/articles/osteosclerosis">osteosclerosis</a>, e.g. <a href="/articles/rugger-jersey-spine-hyperparathyroidism-1">rugger-jersey spine</a>

References changed:

6. Connie Y. Chang, Daniel I. Rosenthal, Deborah M. Mitchell, Atsuhiko Handa, Susan V. Kattapuram, Ambrose J. Huang. Imaging Findings of Metabolic Bone Disease. (2016) RadioGraphics. 36 (6): 1871-1887. <a href="https://doi.org/10.1148/rg.2016160004">doi:10.1148/rg.2016160004</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27726750">Pubmed</a> <span class="ref_v4"></span>

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