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Hyperparathyroidism, Secondary: Multimedia
Updated: Nov 5, 2008
Multimedia
 | Media file 1: Radiograph of the left hand of a 6-year-old girl with chronic renal failure shows ulnar bowing of the distal radius and ulna, mild widening of the growth plates associated with a slight irregularity of the metaphyseal margins, coarsening of the trabecular pattern, and periosteal new bone formation around the metaphyses of the metacarpals and phalanges. The appearance is that of rickets and/or renal osteodystrophy. Note that bone aging is retarded. |
 | Media file 2: Radiograph of the dorsal spine shows the classic rugger-jersey spine. This results from ill-defined bands of increased bone density adjacent to the vertebral endplates. |
 | Media file 3: Radiograph of both hands of a 36-year-old woman receiving long-term hemodialysis shows subperiosteal bone resorption affecting the radial aspect of the middle phalanges of the fingers. Note the extensive digital arterial calcification. |
 | Media file 4: Plain radiograph of the skull of a 39-year-old woman demonstrates malabsorption syndrome with the biochemical features of osteomalacia. The image shows a granular pattern of the skull. Note the brown tumor (arrow). |
 | Media file 5: Posteroanterior (PA) chest radiograph in a 60-year-old woman shows subligamentous bone resorption of the inferior surface of the lateral ends of the clavicles. |
 | Media file 6: Radiograph of the dorsal spine of an adult male shows the classic rugger-jersey spine caused by ill-defined bands of increased bone density adjacent to the vertebral endplates. |
 | Media file 7: Radiograph in a 53-year-old woman with nutritional osteomalacia shows a brown tumor in the region of the tibial tuberosity (left) and healing of the lesion after vitamin D therapy (right). Also note improved mineralization of the bones. |
 | Media file 8: Posteroanterior (PA) chest radiograph shows multiple expansile brown tumors in the medial border of the left scapula and in several of the ribs (black arrows). Also note subperiosteal bone resorption along one of the rib margins (white arrow). |
 | Media file 9: Radiograph of the pelvis (same patient as in Image 8) shows multiple brown tumors (arrows). |
 | Media file 10: Radiograph of the feet (same patient as in Images 8 and 9) shows fairly large para-articular erosions in the heads of the right third and fourth metatarsal bones. Note the organized periosteal reaction around the shafts of those bones. |
 | Media file 11: Anteroposterior (AP) radiograph of the right knee of a 55-year-old man receiving chronic hemodialysis. The patient presented with a red, hot, painful knee. Microscopic analysis of the joint aspirate revealed pyrophosphate crystals. The diagnosis was pseudogout. The radiograph shows chondrocalcinosis. |
 | Media file 12: Occasionally, patients with chronic renal failure may present with biochemical and radiographic features of osteomalacia. This plain radiograph of the pelvis of a 77-year-old woman shows multiple pseudofractures. Note the osteosclerosis and a brown tumor in the region of the intertrochanteric line of the left femur. |
 | Media file 13: Superscan shows diffusely increased activity in the axial skeleton and perhaps in the calvaria and mandible. The ratio of bone to soft tissue is increased, and the kidneys and urinary bladder are absent. |
 | Media file 14: Technetium-99m bone scan in a patient with chronic renal disease shows uptake in the lungs and calvaria. No renal or bladder activity was noted. (The kidneys are not shown.) |
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References
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Further Reading
Procedure guideline for parathyroid scintigraphy.
Society of Nuclear Medicine, Inc - Medical Specialty Society. 1999 Feb (revised 2004 Jun). 6 pages. NGC:004256
Cinacalcet for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy.
National Institute for Health and Clinical Excellence (NICE) - National Government Agency [Non-U.S.]. 2007 Jan. 28 pages. NGC:005508
The American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons position statement on the diagnosis and management of primary hyperparathyroidism. American Association of Clinical Endocrinologists - Medical Specialty Society
American Association of Endocrine Surgeons - Medical Specialty Society. 2005 Jan-Feb. 6 pages. NGC:004187
Keywords
hyperparathyroidism, secondary hyperparathyroidism, osteitis fibrosa cystica, renal osteodystrophy, pronounced parathyroid gland hyperplasia, end-organ resistance to parathyroid hormone, PTH, chronic renal insufficiency, parathyroid glands, parathyroid disease, endocrine system disease, vitamin D supplementation
