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Non-neoplastic or metabolic disease


Reviewers: Dariusz Borys, M.D. (see Reviewers page)
Revised: 8 June 2012, last major update June 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.


● Only 25% have bone disease, usually bone pain
● Presents in young to middle-aged adults with recurring kidney stones, peptic ulcer, nausea, vomiting, weakness, headaches
● Affects entire skeleton, cortical bone more than medullary bone
● Usually detected early, so osteitis fibrosa cystica (severe changes, also called Recklinghausenís disease) is rare
● Skeletal abnormalities with secondary hyperparathyroidism are typically mild

● Parathyroid adenoma of one gland is most common
● Rarely carcinoma or hyperplasia

Radiology description

● Diffuse osteopenia
● Specific pattern for fingers of cortical cutting cones (erosion of tufts of phalanges, subperiosteal cortical resorption, especially on radial side)

Laboratory description

● Marked hypercalcemia and hypophosphatemia

Gross description

● Thin bone cortices, loss of lamina dura around teeth
● Rarely associated with brown tumor of hyperparathyroidism

Micro description

● Increased osteoclastic activity with tunneling of osteoclasts into bone matrix (dissecting resorption)
● Also marked increase in bone formation and peritrabecular fibrosis

Differential diagnosis

● Myelofibrosis: fibrous tissue diffusely throughout marrow, not around trabeculae
● Paget's disease-acute phase: osteoclasts donít tunnel, have more nuclei, different clinical presentation and laboratory findings

End of Bone > Non-neoplastic or metabolic disease > Hyperparathyroidism

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