Conditions Flashcards
Maximum terminal tuft size?
12mm in Men
10mm in Women
Increased Joint spaces
Acromegally
What are potential causes of hypopituitarism?
Neoplasm
Infection
Granulomas
Hemochromatosis
Injury / iatrogenic
Vascular insult
familial / idiopathic
Hypothalamic neoplasm
MCC of hypopitutarism?
Familial (~10%)
Radiographic appearance of hypopituitarism?
Delay in the appearance and growth of ossification centers, and a similar delay in their fusion and disappearance.
Growth rate is 50-60% of normal
Rare side effect of treatment of with GH in hypopituitarism?
SCFE
Causes of thyrotoxicosis (hyperthyroidism)?
MCC: 1. Toxic diffuse goiter (Graves’, Basedow’s)
- Toxic nodular goiter produced by adenomas
Other:
Toxic adenoma
Trophoblastic diseases
Iodine induced
Thyroiditis (subacute, chronic)
Ectopic thyroid tissue
Thyrotoxicosis factitia
Increased (bone related) lab values with hyperthyroidism?
↑ Serum calcium (not severe or sustained)
↑ Serum phosphorus
↑alkaline phosphatase
hypercalciuria
Percent of hyperthroidism that is radiographically evident?
3.5-50%
More likely to see if disease has been occuring >5yrs
More likely if the patient has exopthalmos
Radiographic findings in Hyperthyroidism?
Osteoporosis (expected findings)
Focal cystic lesions resembling multiple myeloma
Latice pattern in hands and feet with cortical striations
Possible path fx
Rarely: looser’s zone in femoral neck
Etiology of osseous changes in Hyperthyroidism?
Hyperosteoblastosis and Hyperosteoclastosis, although resorption dominates
Findings of hyperthyroidism in children?
Accelerated skeletal maturation
Premature craniosynostosis
Thyroid Acropachy occurs?
Generally after treatment for hyperthyroidism, although may be an initial finding of the disease.
non-radiographic Thyroid Acropachy findings?
exopthalmos, progressive painless soft tissue swelling of the fingers and toes, pretibial myxedema, clubbing of the fingers
Thyroid Acropachy radiographic findings?
Periosteal bone formation in diaphyses of metacarpals, metatarsals, & proximal and middle phalanges. May be seen in long bones.
Periostitis that is asymmetric, more on radial aspect, is dense and solid with a feathery contour.
Positive bone scan
Thyroid Acropachy DDX?
Other disorders associated with periosteal bone formation:
Hypertrophic osteoarthropathy (not usually in hands and feet)
Pachydermoperiostosis (Periosteal rxn not limited to diaphysis)
Causes of primary hypothyroidism?
Atrophy
Radiotherapy or Surgery
Hashimoto’s (autoimmune thyroiditis)
Lymphoma
Cystinosis
amyloidosis
Mets
Iodine deficiency (intake or metabolism)
Some meds
Radiographic appearance of adult-onset hypothyroidism?
Occasionally, bone may appear more compact, with increased radiodensity due to decreased bone formation and resorption.
radioghraphic changes in jevenile myxedema and cretinism?
Delayed bony maturation
Infant - absence of the distal femoral and proximal tibial epiphyses
Fragmented irregular epiphyseal contours (epiphyseal dysgenesis)
Delayed dental development
Skull findings in Cretinism
Brachycephaly
Enlarged sella
Prominent sutures with wormian bones
underdevelopment of the paranasal sinuses and mastoid air cells
prognathous lower jaw
Short bullet-shaped T12 & L1
What neuropathy is commonly associated with hypothyroidism?
Carapal tunnel (7%)
What epiphyseal injury may be the presenting feature of adolescent hypothyroidism, or a result of treatment?
SCFE
What osseous complication can be seen with hypothyroidism due to weakening of subchondral bone?
Collapse of surfacces similar to AVN and HPT.
Observed at tibial plateau.
Osteolytic lesions of the epiphyses has also been noted.
Growth hormone aka?
somatotropin
Skull features of acromegally?
Large mandible - “Lantern jaw”
Poor dental occlusion
Separation of the teeth
Large frontal sinus’s
Prominent forehead - Calvarial thickening
prominence of the tongue
Extremity features of acromegally?
Broad, spade-like hands
Fingers are separated and blunted
enlarged frame
widened joints
osteophytosis
cortical thickening
overtubulation phalanges and tetatarsals
Common presenting sx of an acromegallic?
Headaches
visual disturbances
rheumatic complaints/arthropathy
compression neuropathy
fatigue and lethargy
myopathy
Findings in acromegallic myopathy?
increased serum creatinine phosphokinase
decreased mean action potential duration
sesamoids in acromegally?
Sesamoid index >30 is indicative
Spinal findings in acromegally?
Scalloped vertebrae
elongated, wide vertebrae
increased disc height
beaking of the pubic symphysis
increased sternal angle angulation
prominence of costochondral junction
potential cauda equina compression
Cause of parathyroid hyperplasia in renal osteodystrophy?
Phosphate retention
renal osteodystrophy in childhood commonly due to what?
Strutural abnormalities of the urinary tract
Rarely due to chronic inflammatory disease
renal osteodystrophy and endocrine abnormalities?
Osteomalacia and rickets due to lack of vit D coversion
secondary HPT
The pathologic and radiologic findings of renal osteodystrophy are divided into what?
HPT
Rickets
Osteomalacia
Osteoporosis
Soft tissue clacificatoin
vascular calcification
miscellaneous alterations
Causes of primary HPT?
Diffuse hyperplasia (10-40%)
Single adenoma (50-80%0
Multiple adenomas (10%)
Rarely: carcinoma
Causes of secondary HPT?
Chronic renal failure (high serum phosphate)
Malabsorption states: pancreatic insuffiecience, nontropical sprue, gluten enteropathy (low serum phosphate)
Tertiary HPT cause?
Autonomous glad secondarty to long standing secondary HPT
Hypercalcemai DDX?
Hyperproteinemia
Malignancy
Endocrine Disorders
Drugs
Granulomatous Disorders
Pediatric disorders
Immobilization
Miscellaneous
Definition of PHPT?
Hypercalcemia of malignancy in the absence of demonstrable skeletal mets or primary HPT.
Lab perameters in HPT?
Hypercalcemia
Hypophosphatemia
hyperphosphatasia
hypercalciuria
Occasionally: Hyperchloremic acidosis, hydroxyprolinuria, hyperglycemia, hyperuricemia, and hypomagnesemia
Initial complaints with HPT?
Urinary tract calculi and nephrolithiasis
peptic ulcer disease
pancreatitis
10-25% have bone aching and tenderness of peripheral joints and spine
Types of bone resorption by area of bone reabsorbed?
Subperiosteal (*HPT*)
Intracortical
endosteal
subchondral
trabecular
subligamentous
subphyseal
Resorption patterin in hands with HPT?
Subperiosteal along radial aspect of phalanges, particularly the middle phalanges of the 2nd and 3rd digits.
Ulnar aspect affected less.
Sites of subperiosteal resorption in HPT?
Phalangeal Tufts (most sensitive finding)
Medial aspect of proximal tibia, humerus and femur
Superior and inferior margins of ribs
Articular (hands/feet, clavicles, SI’s, symphisis pubis)
Location of most distincive area of subchondral resorption in HPT?
SI joints, may mimic AS
Erosion with reactive new bone formation produces an ill-defined, sclerotic articular margin and “pseudo-widening” of the joint space.
Skull findings in HPT?
Diffuse sclerosis with loss of the diploic space
Focal areas of thickening
well-defined or poorly defined radiopaque areas
“Salt and pepper” skull
When are Brown Tumors observed most often?
Primary HPT
What are brown tumors?
Focal accumulations of fibrous tissue and giant cells.
Can lead to osseous expansion
May undergo necrosis and liquefaction, producting cysts
Radiographic features of Brown Tumors
Well-defined
Single or multiple
Eccentric or cortical in locatioin
MC locations: Facial bones, pelvis, ribs, femora
Bone sclerosis and HPT
More common in secondary HPT
Diffuse sclrosis or localized/patchy (rare in primary)
Location: Metaphyseal, skull, vertebral endplates
causes Rugger-jersey appearance in spine
% of people with HPT and CPPD?
18-40%
Connective tissue effects of HPT?
Capsular and ligamentous laxity and tendinous degradation secondary to enzymatic degradation and direct effect of PT hormone
Infant HPT?
Autosomal recessive
or
Transient, secondary to HypoPT in mother
Multiple Endocrine Neoplasia
Multiple endocrine adenomatosis
Wermer’s Syndrome
95% have primary HPT
Autosomal dominamt
Type IIA is called Sipple’s syndrome
Can resemble Marfan’s
Term for periosteal bone formation in ROD?
periosteal neostosis
Commonly demonstrates a zone of radiolucency between periosteal and parent bone
3 signs of risk for SCFE?
Coxa vara
Subperiosteal erosion on medial aspect of femoral neck
increased width of cartilaginous growth plate
(also uremia > 2yrs)
Sites of ST calcification in ROD?
Corneal and conjunctival tissue
viscera
vasculature
subcutaneous
periarticular
Causes of HypoPT?
postsurgical/posttraumatic
Absence or atrophy of glands (idiopathic)
Maternal HyperPT
Radiation to gland
Features of HypoPT?
MC: Osteosclerosis (generalized or localized)
SubQ calcification
DISH/AS like changes
Thickening of cranial vault and facial bones
Increased intracranial pressure w/ sutural diastasis
ventricular dilatation
calcification of basal gangila
GI hypersecretion and spasm
Labs - Low Ca, high P
PHPT cause?
X-linked dominant
End-organ resistance to PT hormone
PHPT somatotype?
Short stature, obese, round face, brachydactyly
Other - Abnormal dentition, retardation, strabismus, impared taste and olfaction
PHPT characterized by?
Renal unresponsiveness to PTH but normal osseous response
Radiographic features of PHPT and PPHPT?
Can be same as HPT - Suberiosteal resorption, brown tumors, osteosclerosis, periosteal neostosis, and SCFE
______________________________
Short metacarpals (not specific)
perpendicular exostoses (as opposed to pointing away from joint)
calvarial thickening
Bowing of extremitis
basal ganglion calcification
ST calcification
Common presentation for child/adolescent with PHPT?
Tetany
Convulsions
Hyperexcitability
Cramping
Stridor
Acromegally Spine Findings
posterior scalloping
increased disc space
