osteomalacia, rickets, scurvy, HPT Flashcards
describe osteomalacia
altered bone quality
lack of calcium salts deposited
abnormally high ratio of osteoid to mineralized bone
causes of osteomalacia
vitamin D metabolism
renal tubular phosphate loss (X-linked hypophosphatemia familial vitamin D resistant rickets, Fanconi’s syndrome)
radiography of osteomalacia
non specific osteopenia coarsened trabeculation looser zones bone softening deformities basilar invagination acetabular protrusion
what is the best diagnostic feature of osteomalacia
bone biopsy
describe rickets
systemic disease of infant and young children
equivalent to osteomalacia in the adult
rare in western world
deficient in vitamin d, calcium or phosphate
symptoms of rickets
decreased quantity of calcified osteoid
muscle tetany, irritabililty, weakness, delayed development, small stature, bone deformities and pain
soft tissue welling around the growth plates due to hypertrophied cartilage
calcium and phosphorus levels may be normal to low
ELEVATED ALKALINE PHOSPHATASE
radiography of rickets
findings are most prominent in the fastest growing bones in the body
widened, bulky physeal plates and irregulatiry
splaying (cupping) of weakened bone at junction/metaphysis and physis
bowing deformities
“rachitic rosary” of chest due to cartilage overgrown and metaphyseal splaying at costochondral junction of ribs
unique radiographic features of rickets
lack of provisional zone of calcification
paintbrush metaphysis
describe scurvey
AKA barlow’s disease
long term deficiency of vitamin C
mostly involves infants fed pasteurized or boiled milk
occasionally elderly
symptoms of scurvey
spontaneous hemorrhaging due to capillary fragility
cutaneous petechiae, bleeding gums, hematuria
joint swelling, irritability, pain and a tendancy to lie supine and motionless with thighs abducted
scurvy can be mistaken for what?
child abuse
lab findings and imaging findings for scurvy
low serum ascorbic acid levels
cartilage slow to proliferate but is mineralized
bone is osteopenic
radiological features of scurvy
dense zone of provisional calcification
beak like metaphyseal outgrowths extended at right angles to shaft
radiodense sclerosis around epiphysis, radiolucent centrally
Trummerfeld’s zone (radiolucent band may be visible directly beneath zone of provisional calcification
corner sign (irregularity of metaphyseal margins)
describe hyperparathyroidism
overactivity of the parathyroid gland
primary HPT
parathyroid adenoma
MC type
MC cause of hypercalcemia
parathyroid adenoma (90%)
carcinoma, hyperplasia, ecroptic PTH producing tumors
elevated parathromone levels, hypercalcemia, hypophosphatemia
secondary HPT
complication of chronic renal disease
persistant loss of calcium and phosphorus
stimulates PTH release
tertiary HPT
seen in dialysis patients, parathyroid gland acts independent of serum calcium levels
clinical features of HPT
30-50 years
women
signs and symptoms of HPT
bone pain, fractures, weakness, lethargy, polydipsia, polyuria
hypercalcemia leads to muscle weakness, hypotonia
renal stones
pancreatitis
hypercalcemia in primary and tertiary
normal to low calcium in secondary
ALL have elevated alkaline phosphatase and elevated PTH
radiography of HPT
osteopenia subperiosteal resorption distal tuft resorption accentuated trabeculation brown tumors loss of cortial definition soft tissue calcification
what is the most definitive radiographic sign of HPT?
subperiosteal resorption
subperiosteal resorption of HPT
especially at radial margins (middle and proximal phalanges of 2nd and 3rd digits)
outer cortical erosion may appear frayed or lace like
widened joint spaces and osteolysis, especially in the AC and SI joint
axial skeletal problems of HPT
rugger jersey spine
subperiosteal resorption at SI joints
salt and pepper skull
brown tumor
feature of HPT
geographic lytic lesion containing osteoclasts and mononuclear cells and fibroblasts with focal hemorrhages
central and slightly expansile
AKA osteoclastoma
