Prevalence of radiological findings among cases of severe secondary hyperparathyroidism

Abstract

CONTEXT AND OBJECTIVE: Patients with end stage renal disease (ESRD) and secondary hyperparathyroidism (HPT2) are prone to develop heterotopic calcifications and severe bone disease. Determination of the sites most commonly affected would decrease costs and patients' exposure to X-ray radiation. The aim here was to determine which skeletal sites produce most radiographic findings, in order to evaluate hemodialysis patients with HPT2, and to describe the most prevalent radiographic findings. DESIGN AND SETTING:This study was cross-sectional, conducted in one center, the Hospital Universitário Clementino Fraga Filho (HUCFF), in Rio de Janeiro, Brazil. METHODS:Whole-body radiographs were obtained from 73 chronic hemodialysis patients with indications for parathyroidectomy due to severe HPT2. The regions studied were the skull, hands, wrists, clavicles, thoracic and lumbar column, long bones and pelvis. All the radiographs were analyzed by the same two radiologists, with great experience in bone disease interpretation. RESULTS:The most common abnormality was subperiosteal bone resorption, mostly at the phalanges and distal clavicles (94% of patients, each). "Rugger jersey spine" sign was found in 27%. Pathological fractures and deformities were seen in 27% and 33%, respectively. Calcifications were presented in 80%, mostly at the forearm fistula (42%), abdominal aorta and lower limb arteries (35% each). Brown tumors were present in 37% of the patients, mostly on the face and lower limbs (9% each). CONCLUSION:The greatest prevalence of bone findings were found on radiographs of the hands, wrists, lateral view of the thoracic and lumbar columns and femurs. The most prevalent findings were bone resorption and ectopic calcifications.RESUMO CONTEXTO E OBJETIVO: Pacientes com hiperparatireoidismo secundário (HPT2) à insuficiência renal crônica são propensos a desenvolver calcificações ectópicas e grave doença óssea. A determinação dos sítios mais revelantes pode diminuir o custo e a exposição do paciente a radiação desnecessária.O objetivo foi determinar quais locais radiológicos apresentam mais achados radiográficos para avaliar o HPT2 em pacientes em hemodiálise, assim como os achados mais prevalentes. TIPO DE ESTUDO E LOCAL:Estudo transversal, realizado no Hospital Universitário Clementino Fraga Filho (HUCFF), no Rio de Janeiro, Brasil. MÉTODOS:Radiografias de corpo inteiro foram obtidas de 73 pacientes em hemodiálise crônica que tiveram indicação de paratireoidectomia devido a HPT2 grave. As regiões estudadas foram crânio, mãos e punhos, clavículas, coluna torácica e lombar, ossos longos e pélvis. Todas as imagens foram analisadas pelos mesmos dois radiologistas, com grande experiência na interpretação de doenças do osso. RESULTADOS:A alteração mais comum foi reabsorção óssea subperiosteal, principalmente nas falanges distais e clavículas (ambos em 94% de pacientes). Sinal de "rugger jersey" foi descoberto em 27%. Fratura patológica e deformidades foram visualizadas em 27% e 33%, respectivamente.As calcificaçõe...

Secondary Hyperparathyroidism With “Superscan-Like” Hypermetabolic FDG PET/CT Pattern

“…Finally, the increased osteoclastic activity induces subperiostal bone resorbtion and osteopenia, appearing as the typical "rugger jersey" sign on CT on the vertebrae (E). 8,9 The bone patterns seen on FDG PET/CT in this context are close to those described on 99m Tc-MDP. 10 Comparing 99m Tc-MDP and FDG PET/CT would have been interesting, but unfortunately, the patient had not been referred to our institution for the initial explorations of his hyperparathyroidism.…”

Facial disfigurement due to osteitis fibrosa cystica or brown tumor from secondary hyperparathyroidism in patients on dialysis: A systematic review and an illustrative case report

“…Thirty-six cases from three articles were excluded from the analysis as they did not have information on the variables we sought to collect as they only provided group patient data and not individual patient data. 14,27,28 Our total sample consisted of 99 articles (see supplementary material). These articles resulted in 127 cases that were included in the analysis (including our case, see supplementary material).…”

Multiple Brown Tumors and Pathologic Patellar Fracture in a Patient With Secondary Hyperparathyroidism

“…10 The classic findings of HPT include osseous resorption by osteoclasts along osseous surfaces. 11,12 This includes the periosteal, endosteal, and articular surfaces, as well as along the medullary bony surfaces. Resorption along the radial surfaces of the phalan-ges and medial surfaces of the proximal tibiae is characteristic of HPT.…”

“…Uptake of fluorodeoxyglucose in osseous lesions can assist in diagnosis of Brown tumors with HPT, and abnormal uptake of fluoro-deoxyglucose can differentiate primary neoplasms. 12 Fluoro-deoxyglucose positron emission tomography/ n radiologic case study CT can be used to show metabolic regression of Brown tumors after treatment has been administered. 13…”