ENDOCRINE/METABOLIC DISORDERS Flashcards
(22 cards)
ENDOCRINE/METABOLIC CONDITIONS
• Metabolic x 6 1– Osteoporosis 2– Osteomalacia 3– Rickets 4– Scurvy 5– Hypervitaminosis A & D 6– Heavy metal toxicity
• Endocrine x 6 – Acromegaly – Hyperthyroidism – Hypothyroidism – Thyroid acropachy – Hyperparathyroidism – Diabetes Mellitus
know where they go x 12
ENDOCRINE/METABOLIC CONDITIONS
Metabolic x 6
1—GENERALIZED OSTEOPOROSIS
• Osteoporosis = normal bone QUALITY, decreased bone _________
• Generalized = bone density decreased in the majority of the skeleton, esp. ________
Etiologies
– senile and post‐menopausal m.c.
• loss of bone mass 1‐6%/yr after 35
– others include mets., m.m., alcoholism, Cushing’s, steroids, endocrine disorders, drugs, anemia, pregnancy, and diet
General information
– FEMALES affected 4:1 over males
– after age 80, females = males
– evidenced by the 5th decade in females, 6th decade in males
Clinical findings
– may be clinically silent
– can see increased A——— as disease progresses
– symptoms may become apparent when there are FRACTURES
quantity
axial
kyphosis
ENDOCRINE/METABOLIC CONDITIONS
Metabolic x 6
1—GENERALIZED OSTEOPOROSIS
• IMAGING findings‐ AXIAL skeleton
A– Note: do NOT confuse overexposed x‐rays with loss of bone density
B– osteopenia (a descriptive term)
C– loss of 2° stress trabeculae, accentuation of 1° trabeculae
D– vertical striations in the vert. bodies (pseudohemangiomas)
E–“______-_______” cortices
F– compression fractures
(anterior wedge, fish vertebra‐ biconcave), especially in the ___________ spine.
G– Altered spinal curvatures
pencil thin
thoracic
ENDOCRINE/METABOLIC CONDITIONS
Metabolic x 6
1—GENERALIZED OSTEOPOROSIS
Imaging findings‐ APPENDICULAR skeleton A– predominately pelvis and proximal femurs (\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_) B– cortical thinning C– osteopenia D– trabecular accentuation E–\_\_\_\_\_\_\_\_\_\_ (esp. hip and wrist) F– \_\_\_\_\_\_\_\_\_\_ fractures
IMAGING findings‐ "special procedures" A– x‐ray is insensitive, but we can perform \_\_\_\_\_\_\_\_\_\_\_ B– single and dual photon absorptiometry C– QCT (most accurate, expensive)
Ward’s triangle
fractures
insufficiency
radiogrammetry
ENDOCRINE/METABOLIC CONDITIONS
Metabolic x 6
1—GENERALIZED OSTEOPOROSIS
—————“REGIONAL” OSTEOPOROSIS——————-
• Loss of bone density confined to a region
• Etiologies
– _________‐ common following immobilization
– Complex Regional PAIN Syndrome
(Reflex sympathetic dystrophy, Sudeck’s atrophy, causalgia)
• unknown etiology‐ many theories
• typically follow TRAUMA, but can follow STROKE, MI,
myelopathy, others
– Transient osteoporosis of the HIP = (TROH)
‐may be focal form of CRPS
A–Clinical findings‐ DISUSE– those related to cause of disease
B— Clinical findings‐ CRPS
– usually over 50 y.o.
– any combination of pain, swelling, redness, warmth, SHINY skin, trophic skin changes
– often self limiting, takes months
– ____________ condition, manifests UNILATERAL
C—Clinical findings –
Transient Regional Osteoporosis of the Hip (TROH)
– MALES affected more than females
– ___-_____ years peak incidence
– hip arthralgia
– is a self limiting condition
D–Imaging findings
– aggressive, regional osteopenia
(seen within 7‐10 days in disuse, 3‐4 months following cause of CRPS)
• cortical tunneling
• irregular endosteal/periosteal resorption
• spotty and/or band‐ like bone loss
E–Imaging findings– soft tissue changes
• swelling with CRPS
• atrophy with disuse– when females affected by TROH, occurs predominately on the LEFT
– BONE SCAN will be HOT with CRPS and TROH
Disuse
bilateral
20‐40
ENDOCRINE/METABOLIC CONDITIONS
Metabolic x 6
1—GENERALIZED OSTEOPOROSIS–LAST ONE
———–“LOCALIZED OSTEOPOROSIS”————-
A–A focal loss of bone density affecting a small
area
• Etiologies– inflammatory arthritis, focal tumors,_______
• Imaging findings– focal loss of bone density, with other findings of the underlying cause
infection
ENDOCRINE/METABOLIC CONDITIONS
Metabolic x 6
2—OSTEOMALACIA
• Relatively normal bone quantity, poor bone quality
• Results in soft bones
• Etiologies
A– deficiency in calcium, phosphorus, or vit. D metabolism
B– malabsorption syndromes
C– renal lesions
D– uncommon causes: dysplasia/tumor/drug reaction
E–IMAGING FINDINGS =
– generalized osteopenia
– trabecular coarsening and indistinctness
– FRACTURE deformities
•—————- FISH VERTEBRAE———-
• basilar invagination
• _________ __________ (protrusio acetabuli)
• bell‐shaped thorax
• __________ deformities of lower limbs
• kyphoscoliosis
F–Imaging findings
– pseudo‐fractures (femur, scapula, rami, ribs)
triradiate pelvis
bowing
ENDOCRINE/METABOLIC CONDITIONS
Metabolic x 6
3—RICKETS
A— General information – vitamin ___ related
(dietary, metabolism, absorption, production, renal lesions)
B– primarily a disease of the _________ _________
(seen with osteomalacia)
C—Clinical findings
– usually does not manifest until after six months
of age
– may see muscle tetany, irritability, weakness,
delayed development and SHORT stature
– may see BOWING deformities, overgrowth of
cartilage near joints and costochondral junction
(_______ _________)
D–Imaging findings‐
active
– “________ ________” metaphyses
– SPLAYED metaphyses
– non‐calcified zone of prov. Ca++
– generalized osteopenia (osteomalacia)
– BOWING deformities
– rachitic ROSARY
E–Imaging findings‐ healing
– return of the zone of provisional Ca++
– return of bone density
– residual growth disturbances and bowing deformities
D
growth plates
rachitic rosary
paint brush
ENDOCRINE/METABOLIC CONDITIONS
Metabolic x 6
4–SCURVY
A– General information – due to a lack of dietary
vitamin ___ (four months or greater)
– rare in the Western world
– lack of vit. C results in vascular fragility‐‐> spontaneous hemorrhage, easy________, BLEEDING GUMS
B–IMAGE FINDINGS X 4 – generalized osteopenia (osteoporosis)
1– ____ _____ __ _________/scurvy
• dense zone of provisional Ca++
2– ________ _________
• well defined ring around epiphysis
3– _______ ______
• arise from metaphyseal margins
• due to collapse of the scorbutic zone
4–– scorbutic / _________ ____ __ _____________
• lucent region adjacent to the zone of provisional Ca++
– subperiosteal hemorrhage
• becomes visible when healing begins
– can see complete healing with little residual change
C
bruisability
white line of FrankeL
Wimberger’s ring
Pelken’s spurs
Trummerfeld zone of attrition
SEE SLIDE 41
ENDOCRINE/METABOLIC CONDITIONS
Metabolic x 6
5---HYPERVITAMINOSIS A • General information A– osseous changes seen following long term megadoses of vit. A B– clinical findings include dermatitis, pruritus, alopecia, and hepatosplenomegaly C-- Imaging findings – osteopenia – \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ reaction
5--HYPERVITAMINOSIS D • General information – S.T. changes seen following long term mega doses of Vit. D • Imaging findings – Periarticular TUMORAL calcinosis (\_\_\_\_-\_\_\_\_\_ areas of Ca++) – renal Ca++ – vascular Ca++ --SLIDE 45
solid periosteal
mass‐like
ENDOCRINE/METABOLIC CONDITIONS
Metabolic x 6
6—HEAVY METAL TOXICITY
• Lead
– ingested, inhaled, or implanted
– clinically can see abdominal PAIN, encephalopathy, and PARALYSIS
• Imaging findings
– dense, _______ ________ along the zone of prov.
Ca++
– may see MULTIPLE sclerotic bands from multiple episodes
– wide ________ from brain swelling
linear bands
sutures
ENDOCRINE/METABOLIC CONDITIONS
ENDOCRINE x 6
1—-ACROMEGALY
A– Etiology
– 2° to excessive growth hormone secretion
(usually from hormone secreting ______ ________)
– in adults, results in predominate SOFT TISSUE and
membranous BONE overgrowth (acromegaly)
– in adolescence, results in increased length of
bone (_________)
B—Clinical findings
– broad, large hands and feet
– prominent forehead
– _______ _________ syndromes (carpal tunnel, bilateral hemianopsia)
– arthritis
– large body features, especially in MALES
pituitary adenoma
gigantism
nerve compression
ENDOCRINE/METABOLIC CONDITIONS
ENDOCRINE x 6
1----ACROMEGALY A---Imaging findings‐ SKULL – enlarged SELLA turcica (classic, but not invariable) – enlarged FRONTAL sinuses – \_\_\_\_\_\_\_\_\_ mandible (lantern jaw)
B--- Imaging findings‐ SPINE – enlarged \_\_\_\_\_\_\_\_‐‐> premature DJD – INCREASED diameter of \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_ – CANAL stenosis --- POSTERIOR scalloping
prognathic
discs
vertebral bodies
ENDOCRINE/METABOLIC CONDITIONS
ENDOCRINE x 6
1—-ACROMEGALY
A—Imaging findings
‐ hands/feet = _____-______ tufts, widened SHAFTS
– enlarged JOINTS with ___________
– INCREASED soft tissue width
– enlarged HEEL PAD thickness (>20‐26mm)
B— Imaging findings‐ other
– enlarged joints, premature DJD
– large thorax
spade‐like
osteophytes
ENDOCRINE/METABOLIC CONDITIONS
ENDOCRINE x 6
2—HYPERTHYROIDISM
A— General information
– excessive production of thyroid hormones from 1° thyroid disease
– physical findings include enlarged NECK, rapid heart beat, weight LOSS, _______
B— Imaging findings
– generalized ________ is main radiographic finding
– may see INCREASE incidence of FRACTURES
proptosis
**abnormal protrusion or displacement of an eye.
osteopenia
***Osteopenia is a condition in which bone mineral density is lower than normal. It is considered by many doctors to be a precursor to osteoporosis.
ENDOCRINE/METABOLIC CONDITIONS
ENDOCRINE x 6
3---HYPOTHYROIDISM (\_\_\_\_\_\_\_\_\_) A-- Etiology – any condition that results in DECREASED thyroid hormone production in \_\_\_\_\_\_\_\_ B-- Clinical findings – coarse, DRY skin and hair – fatigue, lethargy, mental deficiency – subcutaneous EDEMA C--Imaging findings – delayed \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_ = hallmark – \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ – fragmented epiphyses – \_\_\_\_\_\_\_ VERTEBRA with gibbus deformity
***A Gibbus deformity is a form of structural kyphosis, where one or more adjacent vertebrae become wedged. Gibbus deformity can be a sequela of advanced skeletal tuberculosis and is the result of collapse of vertebral bodies.
CRETINISM
infants
skeletal maturation
wormian bones
SAIL
ENDOCRINE/METABOLIC CONDITIONS
ENDOCRINE x 6
4—THYROID ACROPACHY
A– General information
– an unusual complication (1%) of post‐tx. hyperthyroidism patients
– patient is usually EUthyroid (having a normally functioning thyroid gland) or HYPOthyroid at
manifestation
B— Imaging findings
– thick, irregular _______ _________ in the small
tubular bones of the hands and feet
periosteal reaction
ENDOCRINE/METABOLIC CONDITIONS
ENDOCRINE x 6
5—-HYPER PARA THYROIDISM
A– General information
– FEMALES affected 3:1 over males
– peak age = ____-_______ years
– underlying pathology is increased __________
activity with FIBROUS tissue replacement
B—Etiology‐ PRIMARY
– due to OVERproduction of parathormone 2° to
parathyroid adenoma (90%)
– see hypercalcemia, hypophosphatemia
C—Etiology‐ SECONDARY
– due to overproduction of parathormone 2° to
chronic renal disease
D— Etiology‐ TERTIARY
– seen in dialysis patients, long term renal disease
– parathyroid gland acts independent of serum
calcium levels
***In general, cannot distinguish between
different forms with imaging
30 –50
osteoclastic
ENDOCRINE/METABOLIC CONDITIONS
ENDOCRINE x 6
5—-HYPER PARA THYROIDISM
E— Imaging findings‐ AXIAL SKELETON
– osteopenia
– _________________ SKULL= (granular appearance)
– resorption of lamina dura of the mandible
– ________ ________ SPINE =
(sclerotic bands adjacent to the endplates)
– endplate irregularities
– widened sacroiliac joints and symphysis
(from bone resorption)
F—Imaging findings‐ APPENDICULAR SKELETON
– _________ ___________ = (hallmark)
• RADIAL aspect of the 2nd and 3rd middle phalanges
(pathognomonic)
• DISTAL clavicle, medial aspect of prox. tibial and humeral metaphyses
salt and pepper
rugger jersey
subperiosteal resorption
ENDOCRINE/METABOLIC CONDITIONS
ENDOCRINE x 6
5—-HYPER PARA THYROIDISM
G–Imaging findings‐ APPENDICULAR skeleton
– ________ _______ (osteoclastoma)
• from CLOTTED BLOOD in the BONE
• cystic, _______, may heal and become sclerotic
• like the mandible, pelvis, and ribs
brown tumors
expansile
ENDOCRINE/METABOLIC CONDITIONS
ENDOCRINE x 6
5—-HYPER PARA THYROIDISM
H—Imaging findings‐ SOFT TISSUES = extensive calcifications
• vascular = (_______________ arteriosclerosis)
• periarticular (________ calcinosis)
• nephrolithiasis and nephrocalcinosis
• chondrocalcinosis
Monckeberg’s
tumoral
ENDOCRINE/METABOLIC CONDITIONS
ENDOCRINE x 6
6--DIABETES MELLITUS A-- General information – manifestations are due to DECREASED \_\_\_\_\_\_\_\_ integrity, particularly in LOWER extremity B---- Imaging findings – osteomyelitis and \_\_\_\_\_\_\_ arthritis – neuropathic arthropathies – osteopenia – arteriosclerosis
vascular
septic
