Hyperparathyroidism
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Hyperparathyroidism PowerPoint PPT Presentation


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Hyperparathyroidism. overactivitiy of the parathroid gland PTH strong osteoclastic hormone Primary parathyroid gland adenoma Secondary chronic renal disease Hemodialysis (endstage renal glomerular disease) aka renal osteodystrophy. Primary HPT. most common type

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Hyperparathyroidism

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Hyperparathyroidism

  • overactivitiy of the parathroid gland

  • PTH strong osteoclastic hormone

  • Primary

    • parathyroid gland adenoma

  • Secondary

    chronic renal disease

    • Hemodialysis (endstage renal glomerular disease)

    • aka renal osteodystrophy


Primary HPT

  • most common type

  • mc cause of hypercalcemia

  • parathyroid adenoma 90%)

  • carcinoma, hyperplasia, ectopic PTH producing tumors

  • elevated parathormone levels, hypercalcemia, hypophosphatemia


Secondary HPT

  • complication of chronic renal disease

  • persist loss of calcium and phosphorus

  • stimulates PTH release (high PTH and low to normal calcium)

  • Hyperphosphatemia (kidneys can’t excrete it as well)

  • Tertiary HPT is seen in dialysis patients, parathryoid gland acts independent of serum calcium levels (high PTH and Calcium)

  • Radiographic DDx of types is difficult


  • 30-50 women > men

  • bone pain, fractures, weakness, lethargy, polydipsia, polyuria

  • Hypercalcemia leads to muscle weakness, hypotonia

  • may have renal stones

  • pancreatitis

  • hypercalcemia in primary, normal to low in secondary

  • elevated alkaline phosphatase

  • elevated PTH


stones, bones, abdominal groans and psychiatric moans

(renal stones, peptic ulcers, pancreatitis, confusion, lethargy, weakness)


Parathormone physiology

  • maintains the circulating level of calcium ion

  • stimulates osteoclasts, which reabsorb bone and release calcium and phosphorus ion into the blood stream

  • increase calcium absorption through the small intestine

  • renal tubular phosphate excretion and calcium absorption; upsets homeostasis

  • in secondary HPT; calcium loss and abnormal Vit D formation leads to hypocalcemia and release of PTH


Radiography - HPT

  • Osteopenia

  • Subperiosteal resorption (diagnostic)

  • Distal tuft resorption

  • Accentuated trabeculation

  • Brown tumors (cystic accumulations of fibrous tissue)

  • Loss of cortical definition

  • Soft tissue calcification

    • Metastatic calcification; eg., vascular calcification


Subperiosteal resorption

  • most definitive radiographic sign of HPT

  • esp at the radial margins middle and proximal phalanges of the 2nd and 3rd digits

  • outer cortical erosion may appear frayed or lace like

  • widened joint spaces and osteolysis, esp AC and SI joints


Rugger Jersey spine

Sub-endplatesclerosis


Salt and Pepper Skull


Subchondral resorption


Pre and Post treatment


Renal osteodystrophy


Undifferentiated seronegative spondyloarthropathy (history, clinical presentation and what is the most likely


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