Hyperparathyroidism is a condition caused by excess parathyroid hormone that can lead to changes in bone structure and density. Primary hyperparathyroidism is usually caused by a benign tumor of the parathyroid glands and affects females more than males aged 30-60. Symptoms include those related to hypercalcemia like bone pain. Imaging may show features like brown tumors, osteopenia, and a "salt and pepper skull". Surgical removal of the tumor can resolve the condition and reverse changes except for sites of brown tumors.

1. In the name of GOD

2. Sajad farokhi

3. HYPERPARATHYROIDISM

4. The general changes that can be seen in the jaws include thefollowing:
• 1. Change in size and shape of the bone
• 2. Change in the number, size, and orientation of trabeculae
• 3. Altered thickness and density of cortical structures
• 4. Increase or decrease in overall bone density

5. • Hyperparathyroidism is an endocrine abnormality in which there
is an excess of circulating parathyroid hormone (PTH)
• PTH increases bone remodeling
• PTH increases renal tubular reabsorption of calcium and renal
production of the active vitamin D metabolite 1,25(OH)2D

6. Primary hyperparathyroidism
• usually results from a benign tumor
(adenoma) of one of the four parathyroid
glands (80% to 85%)
• Hyperparathyroidism–jaw tumor
syndrome
• Hyperplastic parathyroid glands
• incidence of primary
hyperparathyroidism is about 0.1%

7. Secondary hyperparathyroidism
• esults from a compensatory increase in the
output of PTH in response to hypocalcemia
• This condition produces clinical and imaging
features similar to primary
hyperparathyroidism.

8. Clinical Features
• Primary hyperparathyroidism affects females two to three times more commonly than males
• occurs mainly in adults 30 to 60 years old
• Clinical manifestations of the disease cover a broad range
• These clinical symptoms are mainly related to hypercalcemia
• The combination of hypercalcemia and an elevated serum level of PTH is diagnostic of primary
hyperparathyroidism
• Laboratory test

9. Imaging Features
• Only about one in five patients with hyperparathyroidism has observable bone
changes
subtle erosions of bone from the subperiosteal surfaces of the phalanges of the hands
General Features :

10. The arrow indicates early subperiosteal erosion on the third phalanx.

11. • Demineralization of the skeleton results in an unusual
radiolucent appearance (generalized osteopenia)
Generalized rarefaction and loss of cortical margins in the thoracic vertebrae.

12. Generalized rarefaction and loss of cortical margins in the cervical vertebrae and mandible

13. • Osteitis fibrosa cystica is seen in advanced cases

15. • In about 10% of cases, brown tumors occur late in the disease

16. .Brown tumors of hyperparathyroidism may appear in any bone but are frequently found in the
facial bones and jaws, particularly in cases of long-standing disease
.These lesions may be multiple within a single bone
.If solitary, the tumor may resemble a central giant cell granuloma or an aneurysmal bone cyst
Axial (A) and coronal (B) MDCT images with bone algorithm of a case of secondary hyperparathyroidism with a brown tumor
involving the maxilla. This tumor has features of a central giant cell granuloma with a granular expanded cortex of the maxilla and
very subtle and ill-defined internal septa

17. .The histologic appearance of a brown tumor is identical to giant cell granuloma

18. • The increased levels of serum calcium result in precipitation of the mineral in
the soft tissues forming punctate or nodular calcifications in the joints and
kidneys
Radiograph depicting bilateral nephrocalcinosis in an adult male patient who initially
presented with features of pancreatitis. Ultimately, hyperparathyroidism was
diagnosed

19. • In prominent hyperparathyroidism, the entire calvaria has a
granular appearance classically known as the “salt and pepper”
skull. This appearance is caused by loss of the central (diploic)
trabeculae and thinning of the cortical tables
Axial (A) and sagittal (B) MDCT images with bone algorithm of a case of secondary
hyperparathyroidism

20. Demineralization and thinning of cortical boundaries often occur
in the jaws,
Jaws
A, Panoramic image. The loss of bone in hyperparathyroidism results in the radiopaque teeth standing
out in contrast to the radiolucent jaws. B, Periapical film of a different case demonstrates the loss of a
distinct lamina dura and the granular texture of the bone pattern.

21. The elevated rate of bone remodeling can cause an abnormal bone
Teeth and Associated Structures
. loss of the lamina dura

22. A and B, Granular bone pattern that was characteristic in all intraoral films. Note the loss of a
distinct lamina dura and floor of the maxillary antrum. C, This view of the same case reveals a
brown tumor related to the apical region of the second and third molars

23. Management
After successful surgical removal of the causative parathyroid adenoma, almost all changes revert to normal.
The only exception may be the site of a brown tumor, which often heals with bone that is more sclerotic than
normal
Many people with this disease are being diagnosed earlier, resulting in fewer severe cases

24. THE END