(3) Nutritional, Metabolic, & Endocrine Disorders Flashcards
In osteomalacia and rickets, bone quality is ____ and quantity is ____
- quality is poor
- quantity is normal/decreased
What are 3 potential causes of osteomalacia and rickets?
- vit D deficiency (diet/sun exposure)
- malabsorption disorders (UC, Chron’s, etc.)
- liver & renal Dz
(seizure meds can also scavenge vit D)
What population does osteomalacia occur in?
adults (growth plates closed)
What population does rickets occur in?
pediatric (open growth plates)
What are the imaging findings of osteomalacia?
Common:
- generalized osteopenia
- pseudoFx’s
Uncommon:
- loss of cortical definition
- deformities
If you discover your patient has osteomalacia, what is your next step?
refer to endocrinology
What are the imaging findings of rickets?
- generalized osteopenia
- widened physis (failure to ossify)
- paintbrush metaphyses
- cupping, fraying of metaphyses
- bowing deformities
- pseudoFx’s
- patho Fx’s
- rachitic rosary
What is the most common cause of bowing deformities in the leg?
idiopathic (genu varum)
What is the term for the radiographic finding of bulbous expansion of the ends of the ribs?
Rachitic rosary
What causes scurvy?
vitamin C deficiency
What population in industrialized countries is at particular risk of developing scurvy?
infants between 4-8 months old fed on pasteurized milk (bottle-fed/boiled) for at least 4 months
What are the clinical features of scurvy?
- cutaneous petechiae (^bruisability)
- bleeding gums
- joint swelling
- irritability
- diffuse pain
What are the radiographic findings of scurvy?
- generalized osteopenia
- white line of Frankel
- Wimberger’s ring
- Pelken spurs
- Trummerfeld zone
- subperiosteal hemorrhage (lifting)
What is the most common cause of primary hyperparathyroidism (HPT)?
Parathyroid adenoma
What causes secondary HPT?
chronic renal Dz
What are the lab findings of secondary HPT?
- _Ca2+
- ^PTH
What are the imaging findings of HPT?
- generalized osteopenia
- bone resorption (subperiosteal, subligamentous, subchondral, ungual tufts)
- rugger jersey spine
- salt & pepper skull
- soft tissue & vascular calcification
- osteoclastomas (Brown tumors)
What specific types of bone resorption may occur in patients with HPT?
- subperiosteal
- subligamentous
- subchondral
- ungual tufts (Acro-osteolysis)
- other sites (SI jt, distal clavicle)
What radiographic finding is considered the hallmark of disease for HPT?
subperiosteal resorption
What is the term for the radiographic finding of bone resorption at the SI joints due to HPT?
pseudosacroilitis
(widens the SI jt space)
What is another term for salt and pepper skull?
pepper pot skull
What is the cause of Acromegaly?
excessive growth hormone secretion from pituitary adenoma after growth plates close
What condition is caused by excess growth hormone secretion prior to growth plate closure?
gigantism
What are the clinical features of Acromegaly?
- malocclusion
- prominent forehead
- thickened tongue (macroglossia)
- broad, large hands
- headache
- carpal tunnel syndrome
- degenerative arthritis
What are the imaging features of Acromegaly?
- sella turcica enlargement (>16mm width, >12mm height)
- ^heel pad thickness (>23mm F, >25mm M)
- lantern jaw
- spade deformities (ungual tufts)
- widened jt spaces (early)
- accelerated DJD (late)
What would cause sella turcica enlargement in a patient with Acromegaly?
macroadenoma
What is the term for a widened mandibular angle seen in Acromegaly?
lantern jaw
If you suspect your patient has acromegaly, what is your next step?
order MRI w/ pituitary protocol
What causes Cushing disease?
excess corticosteroid
(eg. pituitary adenoma -> ^cortisol)
What are the clinical features of Cushing disease?
- buffalo hump
- moon face
- purple striae
- hirsutism (male-pattern facial hair in females)
- HTN
What are the imaging features of Cushing disease?
- generalized osteoporosis
- Fx’s
- osteonecrosis (ICE lesions)
How does the rate of osteonecrosis in Cushing disease compare to patients taking exogenous corticosteroids such as Prednisone?
^osteonecrosis w/ exogenous corticosteroids
