Hyperparathyroidism

Changed by Amir Rezaee, 7 Feb 2015

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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 parathyroid hormone (PTH) lead to increased osteoclastic activity. The resultant bone resorption produces cortical thinning (subperiosteal resorption) and osteopaenia.

Sub types

primary hyperparathyroidism: a parathyroid adenoma is the commonest cause (≈80%) followed by parathyroid hyperplasia (≈15%) ²
secondary hyperparathyroidism: a diffuse, adenomatous hyperplasia, renal osteodystrophy
tertiary hyperparathyroidism: an autonomous parathyroid adenoma caused by the chronic overstimulation of hyperplastic glands in renal insufficiency

Associations

Both syndromes are associated with ~~parathyroid~~multiple adenomas or parathyroid hyperplasia.

Radiographic features

subperiosteal bone resorption: classically affects the radial aspects of the proximal and middle phalanges of the 2^nd and 3^rdfingers
terminal tuft erosion
distal clavicle resorption
rugger-jersey spine
osteopaenia
Brown tumours
~~terminal tuft erosion~~
Salt and pepper sign in 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
osteopaenia
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

~~-</ul><p>Both syndromes are associated with parathyroid hyperplasia.</p><h4>Radiographic features</h4><ul>~~
+</ul><p>Both syndromes are associated with multiple adenomas or parathyroid hyperplasia.</p><h4>Radiographic features</h4><ul>
+<li><a href="/articles/acro-osteolysis-1">terminal tuft erosion</a></li>
+<li><a href="/articles/distal-clavicular-erosion-differential">distal clavicle resorption </a></li>
~~-<li><a href="/articles/acro-osteolysis-1">terminal tuft erosion</a></li>~~
+<li><a href="/articles/chondrocalcinosis">chondrocalcinosis</a></li>
~~-<li><a title="Subperiosteal bone resorption" href="/articles/subperiosteal-bone-resorption">subperiosteal bone resorption </a></li>~~
+<li><a href="/articles/subperiosteal-bone-resorption">subperiosteal bone resorption </a></li>
~~-<li>generalised increased uptake on Tc-<sup>99</sup>m pertechnetate bone scan (focal uptake with adenoma)</li>~~
+<li>
+<a title="Superscan : differential diagnosis" href="/articles/superscan">superscan</a>: generalised increased uptake on Tc-<sup>99</sup>m pertechnetate bone scan (focal uptake with adenoma)</li>

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