Tertiary hyperparathyroidism

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

Hyperparathyroidism is supported biochemically by either an elevated serum parathyroid hormone level or an inappropriately normal level in the setting of hypercalcemia.

Epidemiology

Associations

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

Pathology

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

Subtypes

Radiographic features

Findings in secondary (and tertiary) hyperparathyroidism are often associated with the osteosclerosis of renal osteodystrophy and the osteomalacia of vitamin D deficiency:

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