Bone & joints
Other nonneoplastic
Hyperparathyroidism
Author: Dariusz Borys, M.D.
Topic Completed: 1 June 2012
Minor changes: 13 January 2021
Copyright: 2003-2021, PathologyOutlines.com, Inc.
PubMed Search: hyperparathyroidism[title]bone
Table of Contents
Definition / general | Clinical features | Radiology description | Laboratory | Gross description | Microscopic (histologic) description | Differential diagnosisCite this page: Borys D Hyperparathyroidism. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/bonehyperarathyroidism.html. Accessed April 16th, 2021.
Definition / general
- 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 Recklinghausen’s disease) is rare
- Skeletal abnormalities with secondary hyperparathyroidism are typically mild
Causes:
- Parathyroid adenoma of one gland is most common
- Rarely carcinoma or hyperplasia
Clinical features
Brown tumor of hyperparathyroidism
Osteitis fibrosa cystica
Renal osteodystrophy
- Solitary or multiple
- Treatment: resect parathyroid tumor causing hyperparathyroidism or control hypophosphatemia medically (tumor rapidly regresses)
- Gross description: large lytic lesion resembling bone tumor; brown due to hemorrhage
- Microscopic description: numerous giant cells with interstitial hemorrhage, hemosiderin, microfractures, ingrowth of vascularized fibrous tissue with fibroblasts
- Differential diagnosis:
- Giant cell granuloma: different clinical history and laboratory findings
- Giant cell tumor: more uniformly distributed giant cells, no interstitial hemorrhage, no fibroblastic stromal cells
Osteitis fibrosa cystica
- Also called von Recklinghausens disease of bone
- Micro description: increased bone cell activity, peritrabecular fibrosis, cystic brown tumors
Renal osteodystrophy
- Skeletal changes of chronic renal disease
- Increased osteoclastic bone resorption resembling osteitis fibrosa cystica
- Associated with osteomalacia, osteosclerosis, growth retardation, osteoporosis
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
- Marked hypercalcemia and hypophosphatemia
Gross description
- Thin bone cortices, loss of lamina dura around teeth
- Rarely associated with brown tumor of hyperparathyroidism
Microscopic (histologic) 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 don’t tunnel, have more nuclei, different clinical presentation and laboratory findings
