Hyperparathyroidism
Dr Jeremy Jones and Dr Frank Gaillard et al.
Hyperparathyroidism is the effect of excess parathyroid hormone in the body. It can be primary, secondary or tertiary. There many characteristic imaging features predominantly involving the skeletal system.
Pathology
Increased levels of parathyroid hormone (PTH) lead to increased osteoclastic activity. The resultant bone resortpion 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
- tertiary hyperparathyroidism : an autonomous parathyroid adenoma caused by the chronic overstimulation of hyperplastic glands in renal insufficiency
Associations
Both syndromes are associated with parathyroid hyperplasia.
Radiographic features
- subperiosteal bone resorption : classically affects the radial aspects of the proximal and middle phalanges of the 2nd and 3rd fingers
- rugger-jersey spine
- osteopaenia
- Brown tumours
- terminal tuft erosion
Findings in secondary (and tertiary) hyperparathyroidism are often associated with the osteosclerosis of renal osteodystrophy, and the osteomalacia of vitamin D deficiency:
- sub periosteal bone resorption
- osteopaenia
- osteosclerosis e.g. rugger-jersey spine
- soft tissue calcification
- generalised increased uptake on Tc-99m pertechnetate bone scan (focal uptake with adenoma)
- superior and inferior rib notching
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