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.
Increased levels of parathyroid hormone (PTH) lead to increased osteoclastic activity. The resultant bone resortpion produces cortical thinning (subperiosteal resorption) and osteopaenia.
- primary hyperparathyroidism - a parathyroid adenoma is the commonest cause ( ≈ 80%) followed by parathyroid hyperplasia ( ≈ 15%) 2
- secondary hyperparathyroidism - a diffuse, adenomatous hyperplasia, renal osteodystrophy
- tertiary hyperparathyroidism - an autonomous parathyroid adenoma caused by the chronic overstimulation of hyperplastic glands in renal insufficiency
Both syndromes are associated with parathyroid hyperplasia.
- subperiosteal bone resorption - classically affects the radial aspects of the proximal and middle phalanges of the 2nd and 3rd fingers
- rugger-jersey spine
- Brown tumours
- terminal tuft erosion
- Salt and pepper sign in skull
- sub periosteal bone resorption
- 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
- 1. Khan A, Bilezikian J. Primary hyperparathyroidism: pathophysiology and impact on bone. CMAJ. 2000;163 (2): 184-7. CMAJ (full text) - Free text at pubmed - Pubmed citation
- 2. Clark PB, Perrier ND, Morton KA. Detection of an intrathymic parathyroid adenoma using single-photon emission CT 99mTc sestamibi scintigraphy and CT. AJR Am J Roentgenol. 2005;184 (3): S16-8. AJR Am J Roentgenol (link) - Pubmed citation
- 3. Terai K, Nara H, Takakura K et-al. Vascular calcification and secondary hyperparathyroidism of severe chronic kidney disease and its relation to serum phosphate and calcium levels. Br. J. Pharmacol. 2009;156 (8): 1267-78. doi:10.1111/j.1476-5381.2008.00108.x - Free text at pubmed - Pubmed citation
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