Pediatric Secondary Hyperparathyroidism

  • Etiology:
    — Decreased serum calcium leads to increased parathyroid hormone levels
    — Most common cause is renal disease which leads to decreased vitamin D conversion to active form which leads to renal osteodystrophy
  • Imaging Radiograph:
    — Loss of provisional zone of calcification
    — Widened growth plates
    — Frayed metaphyses
    — Coarsening of trabeculae
    — Demineralization
    — Cortical thinning
    — Classically subperiosteal resorption of radial aspects of middle phalanges of index and long fingers
    — Can cause diffuse thickening of skull
  • DDX:
  • Complications:
  • Treatment:
  • Clinical: Secondary hyperparathyroidism

Radiology Cases of Secondary Hyperparathyroidism

Radiograph of hand of pediatric secondary hyperparathyroidism
AP radiograph of the hand (left) shows widened growth plates and frayed metaphyses of the distal radius and ulna. AP radiograph of the middle 3 fingers (right) shows coarsening of trabeculae, demineralization, cortical thinning and subperiosteal resorption of the middle phalanges.
Radiograph of secondary hyperparathyroidism
AP radiograph of the knee shows widening of the distal physis of the femur and the proximal physis of the tibia and fibula and frayed metaphyses in the same areas.

Radiology Cases of Secondary Hyperparathyroidism and Brown Tumor

Radiograph of secondary hyperparathyroidism with a brown tumor of the fifth metacarpal
AP radiograph of the hand shows a lytic lesion in the fifth metacarpal with coarsening of the trabeculae and periosteal reaction along the radial aspect of the middle phalanges.