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Conditions Flashcards

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1
Q

Maximum terminal tuft size?

A

12mm in Men

10mm in Women

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2
Q

Increased Joint spaces

A

Acromegally

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3
Q

What are potential causes of hypopituitarism?

A

Neoplasm

Infection

Granulomas

Hemochromatosis

Injury / iatrogenic

Vascular insult

familial / idiopathic

Hypothalamic neoplasm

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4
Q

MCC of hypopitutarism?

A

Familial (~10%)

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5
Q

Radiographic appearance of hypopituitarism?

A

Delay in the appearance and growth of ossification centers, and a similar delay in their fusion and disappearance.

Growth rate is 50-60% of normal

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6
Q

Rare side effect of treatment of with GH in hypopituitarism?

A

SCFE

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7
Q

Causes of thyrotoxicosis (hyperthyroidism)?

A

MCC: 1. Toxic diffuse goiter (Graves’, Basedow’s)

  1. Toxic nodular goiter produced by adenomas

Other:

Toxic adenoma

Trophoblastic diseases

Iodine induced

Thyroiditis (subacute, chronic)

Ectopic thyroid tissue

Thyrotoxicosis factitia

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8
Q

Increased (bone related) lab values with hyperthyroidism?

A

↑ Serum calcium (not severe or sustained)

↑ Serum phosphorus

↑alkaline phosphatase

hypercalciuria

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9
Q

Percent of hyperthroidism that is radiographically evident?

A

3.5-50%

More likely to see if disease has been occuring >5yrs

More likely if the patient has exopthalmos

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10
Q

Radiographic findings in Hyperthyroidism?

A

Osteoporosis (expected findings)

Focal cystic lesions resembling multiple myeloma

Latice pattern in hands and feet with cortical striations

Possible path fx

Rarely: looser’s zone in femoral neck

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11
Q

Etiology of osseous changes in Hyperthyroidism?

A

Hyperosteoblastosis and Hyperosteoclastosis, although resorption dominates

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12
Q

Findings of hyperthyroidism in children?

A

Accelerated skeletal maturation

Premature craniosynostosis

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13
Q

Thyroid Acropachy occurs?

A

Generally after treatment for hyperthyroidism, although may be an initial finding of the disease.

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14
Q

non-radiographic Thyroid Acropachy findings?

A

exopthalmos, progressive painless soft tissue swelling of the fingers and toes, pretibial myxedema, clubbing of the fingers

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15
Q

Thyroid Acropachy radiographic findings?

A

Periosteal bone formation in diaphyses of metacarpals, metatarsals, & proximal and middle phalanges. May be seen in long bones.

Periostitis that is asymmetric, more on radial aspect, is dense and solid with a feathery contour.

Positive bone scan

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16
Q

Thyroid Acropachy DDX?

A

Other disorders associated with periosteal bone formation:

Hypertrophic osteoarthropathy (not usually in hands and feet)

Pachydermoperiostosis (Periosteal rxn not limited to diaphysis)

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17
Q

Causes of primary hypothyroidism?

A

Atrophy

Radiotherapy or Surgery

Hashimoto’s (autoimmune thyroiditis)

Lymphoma

Cystinosis

amyloidosis

Mets

Iodine deficiency (intake or metabolism)

Some meds

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18
Q

Radiographic appearance of adult-onset hypothyroidism?

A

Occasionally, bone may appear more compact, with increased radiodensity due to decreased bone formation and resorption.

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19
Q

radioghraphic changes in jevenile myxedema and cretinism?

A

Delayed bony maturation

Infant - absence of the distal femoral and proximal tibial epiphyses

Fragmented irregular epiphyseal contours (epiphyseal dysgenesis)

Delayed dental development

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20
Q

Skull findings in Cretinism

A

Brachycephaly

Enlarged sella

Prominent sutures with wormian bones

underdevelopment of the paranasal sinuses and mastoid air cells

prognathous lower jaw

Short bullet-shaped T12 & L1

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21
Q

What neuropathy is commonly associated with hypothyroidism?

A

Carapal tunnel (7%)

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22
Q

What epiphyseal injury may be the presenting feature of adolescent hypothyroidism, or a result of treatment?

A

SCFE

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23
Q

What osseous complication can be seen with hypothyroidism due to weakening of subchondral bone?

A

Collapse of surfacces similar to AVN and HPT.

Observed at tibial plateau.

Osteolytic lesions of the epiphyses has also been noted.

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24
Q

Growth hormone aka?

A

somatotropin

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25
Skull features of acromegally?
Large mandible - "Lantern jaw" Poor dental occlusion Separation of the teeth Large frontal sinus's Prominent forehead - Calvarial thickening prominence of the tongue
26
Extremity features of acromegally?
Broad, spade-like hands Fingers are separated and blunted enlarged frame widened joints osteophytosis cortical thickening overtubulation phalanges and tetatarsals
27
Common presenting sx of an acromegallic?
Headaches visual disturbances rheumatic complaints/arthropathy compression neuropathy fatigue and lethargy myopathy
28
Findings in acromegallic myopathy?
increased serum creatinine phosphokinase decreased mean action potential duration
29
sesamoids in acromegally?
Sesamoid index \>30 is indicative
30
Spinal findings in acromegally?
Scalloped vertebrae elongated, wide vertebrae increased disc height beaking of the pubic symphysis increased sternal angle angulation prominence of costochondral junction potential cauda equina compression
31
Cause of parathyroid hyperplasia in renal osteodystrophy?
Phosphate retention
32
renal osteodystrophy in childhood commonly due to what?
Strutural abnormalities of the urinary tract Rarely due to chronic inflammatory disease
33
renal osteodystrophy and endocrine abnormalities?
Osteomalacia and rickets due to lack of vit D coversion secondary HPT
34
The pathologic and radiologic findings of renal osteodystrophy are divided into what?
HPT Rickets Osteomalacia Osteoporosis Soft tissue clacificatoin vascular calcification miscellaneous alterations
35
Causes of primary HPT?
Diffuse hyperplasia (10-40%) Single adenoma (50-80%0 Multiple adenomas (10%) Rarely: carcinoma
36
Causes of secondary HPT?
Chronic renal failure (high serum phosphate) Malabsorption states: pancreatic insuffiecience, nontropical sprue, gluten enteropathy (low serum phosphate)
37
Tertiary HPT cause?
Autonomous glad secondarty to long standing secondary HPT
38
Hypercalcemai DDX?
Hyperproteinemia Malignancy Endocrine Disorders Drugs Granulomatous Disorders Pediatric disorders Immobilization Miscellaneous
39
Definition of PHPT?
Hypercalcemia of malignancy in the absence of demonstrable skeletal mets or primary HPT.
40
Lab perameters in HPT?
Hypercalcemia Hypophosphatemia hyperphosphatasia hypercalciuria Occasionally: Hyperchloremic acidosis, hydroxyprolinuria, hyperglycemia, hyperuricemia, and hypomagnesemia
41
Initial complaints with HPT?
Urinary tract calculi and nephrolithiasis peptic ulcer disease pancreatitis 10-25% have bone aching and tenderness of peripheral joints and spine
42
Types of bone resorption by area of bone reabsorbed?
Subperiosteal (\*HPT\*) Intracortical endosteal subchondral trabecular subligamentous subphyseal
43
Resorption patterin in hands with HPT?
Subperiosteal along radial aspect of phalanges, particularly the middle phalanges of the 2nd and 3rd digits. Ulnar aspect affected less.
44
Sites of subperiosteal resorption in HPT?
Phalangeal Tufts (most sensitive finding) Medial aspect of proximal tibia, humerus and femur Superior and inferior margins of ribs Articular (hands/feet, clavicles, SI's, symphisis pubis)
45
Location of most distincive area of **subchondral** resorption in HPT?
SI joints, may mimic AS Erosion with reactive new bone formation produces an ill-defined, sclerotic articular margin and "pseudo-widening" of the joint space.
46
Skull findings in HPT?
Diffuse sclerosis with loss of the diploic space Focal areas of thickening well-defined or poorly defined radiopaque areas "Salt and pepper" skull
47
When are Brown Tumors observed most often?
Primary HPT
48
What are brown tumors?
Focal accumulations of fibrous tissue and giant cells. Can lead to osseous expansion May undergo necrosis and liquefaction, producting cysts
49
Radiographic features of Brown Tumors
Well-defined Single or multiple Eccentric or cortical in locatioin MC locations: Facial bones, pelvis, ribs, femora
50
Bone sclerosis and HPT
More common in secondary HPT Diffuse sclrosis or localized/patchy (rare in primary) Location: Metaphyseal, skull, vertebral endplates causes Rugger-jersey appearance in spine
51
% of people with HPT and CPPD?
18-40%
52
Connective tissue effects of HPT?
Capsular and ligamentous laxity and tendinous degradation secondary to enzymatic degradation and direct effect of PT hormone
53
Infant HPT?
Autosomal recessive or Transient, secondary to HypoPT in mother
54
Multiple Endocrine Neoplasia Multiple endocrine adenomatosis Wermer's Syndrome
95% have primary HPT Autosomal dominamt Type IIA is called Sipple's syndrome Can resemble Marfan's
55
Term for periosteal bone formation in ROD?
periosteal neostosis Commonly demonstrates a zone of radiolucency between periosteal and parent bone
56
3 signs of risk for SCFE?
Coxa vara Subperiosteal erosion on medial aspect of femoral neck increased width of cartilaginous growth plate (also uremia \> 2yrs)
57
Sites of ST calcification in ROD?
Corneal and conjunctival tissue viscera vasculature subcutaneous periarticular
58
Causes of HypoPT?
postsurgical/posttraumatic Absence or atrophy of glands (idiopathic) Maternal HyperPT Radiation to gland
59
Features of HypoPT?
**MC:** Osteosclerosis (generalized or localized) SubQ calcification DISH/AS like changes Thickening of cranial vault and facial bones Increased intracranial pressure w/ sutural diastasis ventricular dilatation calcification of basal gangila GI hypersecretion and spasm Labs - Low Ca, high P
60
PHPT cause?
X-linked dominant End-organ resistance to PT hormone
61
PHPT somatotype?
Short stature, obese, round face, brachydactyly Other - Abnormal dentition, retardation, strabismus, impared taste and olfaction
62
PHPT characterized by?
Renal unresponsiveness to PTH but normal osseous response
63
Radiographic features of PHPT and PPHPT?
Can be same as HPT - Suberiosteal resorption, brown tumors, osteosclerosis, periosteal neostosis, and SCFE \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Short metacarpals (not specific) perpendicular exostoses (as opposed to pointing away from joint) calvarial thickening Bowing of extremitis basal ganglion calcification ST calcification
64
Common presentation for child/adolescent with PHPT?
Tetany Convulsions Hyperexcitability Cramping Stridor
65
Acromegally Spine Findings
posterior scalloping increased disc space

Endocrine Disorders (12 decks)

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