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 :
- multiple endocrine neoplasia type I (MEN1)
- multiple endocrine neoplasia type IIa (MEN2a)
- familial hypocalciuric hypercalcemia
- familial isolated primary hyperparathyroidism
- hyperparathyroidism-jaw tumor syndrome
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%)
- parathyroid hyperplasia (10-15%)
- parathyroid carcinoma (1-5%)
- parathyroid adenoma (~80%)
- secondary hyperparathyroidism
- caused by chronic hypocalcemia with renal osteodystrophy being the most common cause (others include malnutrition, vitamin D deficiency)
- results in parathyroid hyperplasia
- tertiary hyperparathyroidism
- autonomous parathyroid adenoma caused by the chronic overstimulation of hyperplastic glands in renal insufficiency
Radiographic features
- subperiosteal bone resorption
- classically affects the radial aspects of the proximal and middle phalanges of the 2 and 3fingers
- 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
- terminal tuft erosion (acro-osteolysis)
- rugger jersey spine
- osteopenia
- brown tumors
- salt and pepper sign in the 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
- osteopenia
- osteosclerosis, e.g. rugger jersey spine
- soft tissue calcification
- superscan: generalized increased uptake on Tc-99m pertechnetate bone scan (focal uptake with adenoma)
- superior and inferior rib notching
Siehe auch:
- Brauner Tumor
- Renale Osteodystrophie
- Weichteilverkalkungen
- Osteomalazie
- Rugger-Jersey-Wirbelsäule
- Nebenschilddrüsenadenom
- MEN IIa
- multiple endokrine Neoplasie Typ 1
- chronische Niereninsuffizienz
- subperiostale Knochenresorption
- Engel-von-Recklinghausen-Syndrom
- tertiärer Hyperparathyreoidismus
- selective blood sampling hyperparathyroidism
- superior and inferior rib notching
- skeletal manifestations of primary hyperparathyroidism
- Leitlinie Primärer Hyperparathyreoidismus
- Rattenbissnekrosen
und weiter:
- Basalganglienverkalkungen
- Gicht
- Bulbus-oculi-Verkalkungen
- primärer Hyperparathyreoidismus
- Rachitis
- hypercalcemia
- Basiläre Impression
- Riesenzelltumor
- calcaneal tuberosity avulsion fracture
- vegetable and plant inspired signs
- Sakroiliitis
- ACJ erosion
- Rippenusuren
- osteitis pubis
- medulläre Nephrokalzinose
- Hyperostosis Kalotte
- medullary sponge kidney
- Chondrokalzinose
- Pfeffer-und-Salz-Schädel
- tumoröse Kalzinose
- differential diagnosis of calcified pulmonary densities
- vascular calcification
- Osteolyse der distalen Klavikula
- chondrocalcinosis (mnemonic)
- lytic bone lesion (mnemonic)
- basilar invagination (mnemonic)
- central giant cell granuloma
- Achillessehnenruptur
- metastatic calcification in the brain
- distal clavicular erosion
- acro-osteolysis (mnemonic)
- multiple benign lucent bone lesions (mnemonic)
- renal osteodystrophy of the skull vault
- Metaphysäre Chondrodysplasie Typ Jansen
- ISG-Sklerose
- Iliosakralgelenksarthrose
- soft tissue calcification (mnemonic)
- Verkalkungen der Blase
- Parathormon
- Pseudohyperparathyreoidismus
- differential diagnosis of generalized osteopaenia
- generalised osteopaenia
- Rugger Jersey Spine Osteoporose
- tuberculosis dactylitis
- dens erosion
- echogenic renal pyramids
- hyperparathyroidism: subperiosteal bone resorption
- Hyperparathyreoidismus Dialyse
- ectopic hyperparathyroidism
- acro-osteolysis in hyperparathyroidism
- Osteoporosis circumscripta
- Osteoklastom
- giant cell reparative cyst
- Kalziumpyrophosphat-Ablagerungskrankheit
- sekundärer Hyperparathyreoidismus
- Riesenzelltumor des Knochens
- CT Hyperparathyreoidismus
- Superscan Szintigraphie
- Leistenschmerz bei Sportlern
- Sklerosierung der Klavikula
- tuberkulöse Daktylitis
- Knochenläsionen der Diaphyse
