Secondary Hyperparathyroidism

Plain X-ray hands of a young patient with CRF shows signs of secondary hyperparathyroidism (HPTH):
-Irregular, frayed and ill-defined cortical outline, pronounced at radial aspect of middle phalanges –> subperiosteal bone resorption
-Multiple lytic expansile lesions –> brown tumors (arrows)
-Accentuated trabecular pattern (non essential trabeculae are resorbed; those that remain appear prominent).

Renal osteodystrophy:
– Constellation of musculoskeletal abnormalities that occur in patients with CRF.
Manifestations include:
-Osteomalacia (adults) / rickets (children).
-Secondary HPTH: bone resorption, osteosclerosis, soft tissue & vascular calcifications and brown tumors.
-Aluminum intoxication if the patient is on dialysis (beyond description here).

Comment: Subperiosteal bone resorption is the hallmark of HPTH and is first identified in hands.

1. Manaster B.J.: Handbook of skeletal radiology: Trauma 1997. Mosby.
2. Youchum and Rowe’s: Essentials of Skeletal Radiology 2005. Lippincott, Williams & Wilkins

Credit: Dr Ahmed Haroun