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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
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
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
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
slide5
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
slide6

stones, bones, abdominal groans and psychiatric moans

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

parathormone physiology
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
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
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
Rugger Jersey spine

Sub-endplatesclerosis

slide18

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

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