These are the Two Xrays (One is Xray KUB and Other one is Xray of the Pelvis) taken from a woman was complaining of Lower back and Loin pain for 3 weeks duration.Along with that she also had lassitude and dyspepsia.Comment on these two Xrays?And What are the Biochemical tests that you would like to do on this situation?






ANSWER - PARATHYROID OSTEODYSTROPHY ( osteitis fibrosa cystica)DUE TO PRIMARY HYPERPARATHYROIDISM
TOP XRAY - RENAL CALCULI IN THE LEFT KIDNEY 
BOTTOM XRAY - HYPERLUCENT AREAS(CYSTIC LESIONS) AROUND THE ANTERIOR SUPERIOR ILIAC SPINE ON BOTH SIDES,PROMINENT ON THE LEFT SIDE
 
Hyperparathyroidism is overactivity of the parathyroid glands resulting in excess production of parathyroid hormone (PTH). The principal target organs Of PTH are the kidney and bone, with a secondary effect on the gut through 1,25 dihydroxy vitamin D.

Primary hyperparathyroidism
Primary hyperparathyroidism results from a hyperfunction of the parathyroid glands
It is most common between 40 and 60 years of age when it is twice as common in women than men

Causes

  1. Parathyroid adenoma of the chief or clear cells of the parathyroid gland(80%)
  2. Multiple adenomas - 5%
  3. Carcinoma of the gland- 2%
  4. Ectopic PTH-secreting tumour

Clinical features

  1. Lassitude
  2. Bone resorption leading to bone pain, pathological fracture, and rarely, osteitis fibrosa cystica(Osteitis fibrosa cystica is most common in severe primary hyperparathyroidism and Skeletal changes are most prominent at the sites of highest bone activity - trabecular bones of vertebrae, phalanges, the ends of long bones, and parts of the skull.)
  3. Renal calculi
  4. Polyuria, thirst
  5. Vomiting
  6. Rarely acute pancreatitis , corneal calcification

Investigations

  • High serum Calcium
  • serum alkaline phosphatase may increase
  • Low serum Phosphate
  • serum alkaline phosphatase - often normal but may be markedly increased in bone disease
  • Increase urine Calcium
  • High levels of serum PTH
  • metabolic acidosis
  • Bone XRAYS
           Earlier sign is irregular subperiosteal cortical erosions in the phalanges of the fingers
           Loss of bone density
           Very thin cortices
           Cystic lesions - brown tumours - may occur elsewhere in the skeleton - appear as rounded radiolucent lesions which are trabeculated.This is a late feature
           Bone resorption in the skull gives a stippled 'pepper pot' appearance

  •  Ultrasound of the neck may reveal a thyroid parathyroid adenoma

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6 comments

  1. Anonymous Says:
  2. calcinates can be caused by hyperparathyroidism.
    Bio tests: Ca, parathormon

     
  3. Anonymous Says:
  4. Calcifications with in the renal parenchyma, associated with diminished bone denisity.
    S.Ca, parthyroid hormone, urine calcium.

     
  5. Anonymous Says:
  6. clinical cases
    http://www.facebook.com/thenewenglandjournalofmedicine

     
  7. Anonymous Says:
  8. osteolytic lesion + calcification
    lab:cbcd/ESR/BUN/creat./Ca./
    urine(protein)
    bone scan

     
  9. Anonymous Says:
  10. nephrocalcinosis,bone cyst changes off hyperparathyroiis..

     
  11. Yousof Says:
  12. nephrocalcinosis and generalized osteopenia, because of hyperparathyroidism. if age is > 50 then R/O of malignancy, such as Multiple Myeloma.
    CBC, ESR, U/A, Ca, P, PTH

     

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