Hyperparathyroidism
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- updated 11 May 2022:
Nothing to disclose
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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.
Clinical presentation
Parathyroid hormone affects multiple organs. The most common symptoms are bone pain, chronic fatigue, polyuria, headache, decreased concentration and depression. Also, patients can present with complications like renal stones, fractures, cardiac arrhythmia, and hypertension.
Hyperparathyroidism is supported biochemically by either an elevated serum parathyroid hormone level or an inappropriately normal level in the setting of hypercalcemiahypercalcaemia.
Epidemiology
Associations
Hyperparathyroidism can occur in the context of the following conditions from parathyroid hyperplasia or less commonly multiple parathyroid adenomas 5:
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
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
Radiographic features
-
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)
-
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
salt and pepper sign in the skull (pepper pot skull)
Findings in secondary (and tertiary) hyperparathyroidism are often associated with the osteosclerosis of renal osteodystrophy and the osteomalacia of vitamin D deficiency:
superscan: generalised increased uptake on Tc-99m pertechnetate bone scan (focal uptake with adenoma)
-<p><strong>Hyperparathyroidism </strong>is the effect of excess <a href="/articles/parathyroid-hormone">parathyroid hormone</a> in the body. It can be primary, secondary, or tertiary. There are many characteristic imaging features, predominantly involving the skeletal system.</p><h4>Clinical presentation</h4><p>Hyperparathyroidism is supported biochemically by either an elevated serum parathyroid hormone level or an inappropriately normal level in the setting of hypercalcemia.</p><h4>Epidemiology</h4><h5>Associations</h5><p>Hyperparathyroidism can occur in the context of the following conditions from parathyroid hyperplasia or less commonly multiple parathyroid adenomas <sup>5</sup>:</p><ul>-<li><a href="/articles/multiple-endocrine-neoplasia-type-1-2">multiple endocrine neoplasia type I (MEN1)</a></li>-<li><a href="/articles/men-2a">multiple endocrine neoplasia type IIa (MEN2a)</a></li>-<li><a href="/articles/familial-hypocalciuric-hypercalcaemia">familial hypocalciuric hypercalcaemia</a></li>-<li><a href="/articles/familial-isolated-primary-hyperparathyroidism">familial isolated primary hyperparathyroidism</a></li>-<li><a href="/articles/hyperparathyroidism-jaw-tumour-syndrome-2">hyperparathyroidism-jaw tumour syndrome</a></li>- +<p><strong>Hyperparathyroidism </strong>is the effect of excess <a href="/articles/parathyroid-hormone">parathyroid hormone</a> in the body. It can be primary, secondary, or tertiary. There are many characteristic imaging features, predominantly involving the skeletal system.</p><h4>Clinical presentation</h4><p>Parathyroid hormone affects multiple organs. The most common symptoms are bone pain, chronic fatigue, polyuria, headache, decreased concentration and depression. Also, patients can present with complications like renal stones, fractures, cardiac arrhythmia, and hypertension.</p><p>Hyperparathyroidism is supported biochemically by either an elevated serum parathyroid hormone level or an inappropriately normal level in the setting of hypercalcaemia.</p><h4>Epidemiology</h4><h5>Associations</h5><p>Hyperparathyroidism can occur in the context of the following conditions from parathyroid hyperplasia or less commonly multiple parathyroid adenomas <sup>5</sup>:</p><ul>
- +<li><p><a href="/articles/multiple-endocrine-neoplasia-type-1-2">multiple endocrine neoplasia type I (MEN1)</a></p></li>
- +<li><p><a href="/articles/men-2a">multiple endocrine neoplasia type IIa (MEN2a)</a></p></li>
- +<li><p><a href="/articles/familial-hypocalciuric-hypercalcaemia">familial hypocalciuric hypercalcaemia</a></p></li>
- +<li><p><a href="/articles/familial-isolated-primary-hyperparathyroidism">familial isolated primary hyperparathyroidism</a></p></li>
- +<li><p><a href="/articles/hyperparathyroidism-jaw-tumour-syndrome-2">hyperparathyroidism-jaw tumour syndrome</a></p></li>
-<strong>primary hyperparathyroidism</strong><ul>- +<p><strong>primary hyperparathyroidism</strong></p>
- +<ul>
-<a href="/articles/parathyroid-adenoma">parathyroid adenoma</a> (~80%)<ul><li>multiple parathyroid adenomas (4%) <sup>5</sup>-</li></ul>- +<p><a href="/articles/parathyroid-adenoma">parathyroid adenoma</a> (~80%)</p>
- +<ul><li><p>multiple parathyroid adenomas (4%) <sup>5</sup></p></li></ul>
-<li>-<a href="/articles/parathyroid-hyperplasia">parathyroid hyperplasia</a> (10-15%) <sup>2,5</sup>-</li>-<li>-<a href="/articles/parathyroid-carcinoma">parathyroid carcinoma</a> (1-5%) <sup>4,5</sup>-</li>-<li>-<a href="/articles/parathyromatosis">parathyromatosis</a> (very rare)</li>- +<li><p><a href="/articles/parathyroid-hyperplasia">parathyroid hyperplasia</a> (10-15%) <sup>2,5</sup></p></li>
- +<li><p><a href="/articles/parathyroid-carcinoma">parathyroid carcinoma</a> (1-5%) <sup>4,5</sup></p></li>
- +<li><p><a href="/articles/parathyromatosis">parathyromatosis</a> (very rare)</p></li>
-<strong>secondary hyperparathyroidism</strong><ul>-<li>caused by chronic hypocalcaemia with <a href="/articles/renal-osteodystrophy">renal osteodystrophy</a> being the most common cause (others include malnutrition, <a href="/articles/vitamin-d-deficiency-overview">vitamin D deficiency</a>) <sup>4</sup>-</li>-<li>results in <a href="/articles/parathyroid-hyperplasia">parathyroid hyperplasia</a> <sup>7</sup>-</li>- +<p><strong>secondary hyperparathyroidism</strong></p>
- +<ul>
- +<li><p>caused by chronic hypocalcaemia with <a href="/articles/renal-osteodystrophy">renal osteodystrophy</a> being the most common cause (others include malnutrition, <a href="/articles/vitamin-d-deficiency-overview">vitamin D deficiency</a>) <sup>4</sup></p></li>
- +<li><p>results in <a href="/articles/parathyroid-hyperplasia">parathyroid hyperplasia</a> <sup>7</sup></p></li>
-<strong>tertiary hyperparathyroidism</strong><ul><li>autonomous parathyroid adenoma caused by the chronic overstimulation of hyperplastic glands in renal insufficiency</li></ul>- +<p><strong>tertiary hyperparathyroidism</strong></p>
- +<ul><li><p>autonomous parathyroid adenoma caused by the chronic overstimulation of hyperplastic glands in renal insufficiency</p></li></ul>
-<a href="/articles/subperiosteal-bone-resorption">subperiosteal bone resorption</a><ul>-<li>classically affects the radial aspects of the proximal and middle phalanges of the 2<sup>nd</sup> and 3<sup>rd </sup>fingers</li>-<li>medial aspect of tibia, femur, humerus</li>-<li>lamina dura: <a href="/articles/floating-teeth">floating teeth</a> (not specific)</li>- +<p><a href="/articles/subperiosteal-bone-resorption">subperiosteal bone resorption</a></p>
- +<ul>
- +<li><p>classically affects the radial aspects of the proximal and middle phalanges of the 2<sup>nd</sup> and 3<sup>rd </sup>fingers</p></li>
- +<li><p>medial aspect of tibia, femur, humerus</p></li>
- +<li><p>lamina dura: <a href="/articles/floating-teeth">floating teeth</a> (not specific)</p></li>
-<li>subchondral resorption<ul>-<li><a href="/articles/distal-clavicular-erosion-differential">lateral end of the clavicles</a></li>-<li><a href="/articles/pubic-symphysis">symphysis pubis</a></li>-<li><a href="/articles/sacroiliac-joint">sacroiliac joints</a></li>- +<li>
- +<p>subchondral resorption</p>
- +<ul>
- +<li><p><a href="/articles/distal-clavicular-erosion-differential">lateral end of the clavicles</a></p></li>
- +<li><p><a href="/articles/pubic-symphysis">symphysis pubis</a></p></li>
- +<li><p><a href="/articles/sacroiliac-joint">sacroiliac joints</a></p></li>
-<li>subligamentous resorption<ul>-<li>ischial tuberosity</li>-<li>trochanters</li>-<li>inferior surface of calcaneus and clavicle</li>- +<li>
- +<p>subligamentous resorption</p>
- +<ul>
- +<li><p>ischial tuberosity</p></li>
- +<li><p>trochanters</p></li>
- +<li><p>inferior surface of calcaneus and clavicle</p></li>
-<li>intracortical resorption: cigar/oval-shaped or tunnel-shaped radiolucency in the cortex</li>-<li><a href="/articles/acro-osteolysis-1">terminal tuft erosion (acro-osteolysis)</a></li>-<li><a href="/articles/rugger-jersey-spine-hyperparathyroidism-1">rugger jersey spine</a></li>-<li><a href="/articles/generalised-osteopenia-1">osteopenia</a></li>-<li><a href="/articles/brown-tumour">brown tumours</a></li>-<li>-<a href="/articles/salt-and-pepper-sign-skull-1">salt and pepper sign</a> in the skull (pepper pot skull)</li>-<li><a href="/articles/chondrocalcinosis">chondrocalcinosis</a></li>- +<li><p>intracortical resorption: cigar/oval-shaped or tunnel-shaped radiolucency in the cortex</p></li>
- +<li><p><a href="/articles/acro-osteolysis-1">terminal tuft erosion (acro-osteolysis)</a></p></li>
- +<li><p><a href="/articles/rugger-jersey-spine-hyperparathyroidism-1">rugger jersey spine</a></p></li>
- +<li><p><a href="/articles/generalised-osteopenia-1">osteopenia</a></p></li>
- +<li><p><a href="/articles/brown-tumour">brown tumours</a></p></li>
- +<li><p><a href="/articles/salt-and-pepper-sign-skull-1">salt and pepper sign</a> in the skull (pepper pot skull)</p></li>
- +<li><p><a href="/articles/chondrocalcinosis">chondrocalcinosis</a></p></li>
-<li><a href="/articles/subperiosteal-bone-resorption">subperiosteal bone resorption </a></li>-<li><a href="/articles/generalised-osteopenia-1">osteopenia</a></li>-<li>-<a href="/articles/osteosclerosis">osteosclerosis</a>, e.g. <a href="/articles/rugger-jersey-spine-hyperparathyroidism-1">rugger jersey spine</a>-</li>-<li><a href="/articles/soft-tissue-calcification-2">soft tissue calcification </a></li>-<li>-<a href="/articles/superscan">superscan</a>: generalised increased uptake on Tc-99m pertechnetate bone scan (focal uptake with adenoma)</li>-<li><a href="/articles/rib-notching">superior and inferior rib notching</a></li>- +<li><p><a href="/articles/subperiosteal-bone-resorption">subperiosteal bone resorption</a></p></li>
- +<li><p><a href="/articles/generalised-osteopenia-1">osteopenia</a></p></li>
- +<li><p><a href="/articles/osteosclerosis">osteosclerosis</a>, e.g. <a href="/articles/rugger-jersey-spine-hyperparathyroidism-1">rugger jersey spine</a></p></li>
- +<li><p><a href="/articles/soft-tissue-calcification-2">soft tissue calcification</a></p></li>
- +<li><p><a href="/articles/superscan">superscan</a>: generalised increased uptake on Tc-99m pertechnetate bone scan (focal uptake with adenoma)</p></li>
- +<li><p><a href="/articles/rib-notching">superior and inferior rib notching</a></p></li>
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