Hyperparathyroidism

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Hyperparathyroidism

  1. 1. Hyperparathyroidism
  2. 2. • Uncontrolled production of parathormone hormone.
  3. 3. Primary hyperparathyroidism • • • • Parathyroid hyperplasia. Parathyroid adenoma. Parathyroid carcinoma. It may be part of MEN (Multiple Endocrine Neoplasia) syndromes. MEN type I 3P •Parathyroid adenoma, •Pituitary adenoma & •Pancreatic islet cell tumor MEN type II PTP •Parathyroid adenoma, •Thyroid medullary carcinoma & •Pheocrhomocytoma
  4. 4. Secondary hyperparthyroidism • Hyperplasia of the parathyroid in response to decreased serum calcium level. Causes of 2ry hyperparathyroidism: • Renal osteodystrophy.
  5. 5. Tertiary hyperparathyroidism • Autonomous parathyroid nodule on top of parathyroid hyperplasia.
  6. 6. Pathophysiology Action of parathormone hormone: Increase serum calcium level by: Decrease serum phosphate level by: Ca re-absorption from renal Increase serum excretion tubules. of phosphate. Ca absorption from the GIT. Bone resorption
  7. 7. Radiological manifestations
  8. 8. Bone resorption
  9. 9. 1. Subperiosteal bone resorption • Pathogonomonic for hyperparathyroidism. • Lace like irregularity of the cortical margin progressing to scalloping & spiculation (pseudo-periosteitis). Location: Phalangeal tufts. Radial aspects of the middle phalanges of the middle 3 fingers. Distal end of the clavicle Medial tibial metaphysis. Medial femoral neck Medial humeral metaphysis Superior & inferior margins of ribs. Lamina dura.
  10. 10. Loss of lamina dura in Hyperparathyroidism
  11. 11. 2. Subchondral bone resorption • Subchondral bone erosion, sclerosis with narrowing of the joint space. Location: • DIP joint (most commonly the ring & little fingers). • MCP joint. • Clavicular side of AC joint. • Iliac side of SI joint.
  12. 12. DIP joint MCP joint AC joint
  13. 13. SI joint
  14. 14. 3. Intracortical bone resorption Cortica tunneling
  15. 15. 4. Endosteal bone resorption Endosteal scalloping
  16. 16. 5. Trabecular bone resorption • Spotty deossification. Location: Skull (salt & pepper skull).
  17. 17. 6. Subligamentous bone resorption Location: • Calcaneal insertion of plantar aponeurosis. • Clavicular inserstion of coraco-clavicular ligament.
  18. 18. 7. Subtendinous Greater trochanter hip abductors Lesser troachanter Iliopsoas Anterior inferior iliac spine Rectus femoris Ischial tuberosity Hamstrings. Humeral tuberosity Rotator cuff Calcaneal tuberosity Achilles tendon.
  19. 19. Diffuse osteopenia
  20. 20. Regional osteosclerosis • More common in 2ry hyperparathyroidism. Location: Vertebral column (Rugger jersey spine).
  21. 21. English Ruggby sweater Rugger jersey spine
  22. 22. Bone softening • • • • Bowing of long bones. Biconcave vertebral bodies. Kyphoscoliotic deformity. Basilar invagination
  23. 23. Periostitis PTH stimulation of osteoblasts. Solid or lamellar. Location: Superior pubic ramus. Ilio-pecitneal line.
  24. 24. Brown tumor (osteitis fibrosa cystica) • Replacement of bone by vascularized fibrous tissue secondary to PTH stimulated osteoclastic activity • Expansile lytic lesion with well defined non sclerotic margin. Location: They are usually eccentric
  25. 25. DD of Chondrocacinosis
  26. 26. Visceral calcification • Nephrocalcinosis. • Nephrolithiasis.
  27. 27. Renal Calcification Renal Calcification Nephrocalcinosis Nephrocalcinosis Nephrolithiasis Nephrolithiasis Parenchymal calcification Parenchymal calcification Pelvicalyceal calcification Pelvicalyceal calcification
  28. 28. 1ry Vs 2ry hyperparathyroidism Primary hyperparathyroidism Secondary hyperparathyroidism Osteopenia Osteoscelrosis (Rugger Jersy spine) Osteomalacia (looser zone)
  29. 29. Imaging of the parathyroid gland • Thyroid ultrasound. • Technitium sestamibi subtraction scintigraphy.
  30. 30. Technitium sestamibi subtraction scintigraphy.

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