CASE 1834 Published on 18.11.2002
0

Acro-osteolysis in hyperparathyroidism

Section

Musculoskeletal system

Case Type

Clinical Cases

Authors

N.Ramesh,M O Dowd,A.Fernandes,G D Hurley.

Connected authors
Patient

40 years, male

Categories
No Area of Interest ; Imaging Technique Digital radiography, Digital radiography
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Clinical History
Increased tiredness and pain in the hands.
Imaging Findings
The patient complained of increased tiredness and pain in his hands. Blood tests and radiographs of his hands were performed. The blood tests revealed hypercalcaemia. Radiographs of the hand showed erosions of the tufts (tips) of the terminal phalanges and sub-periosteal erosions along the radial aspect of the middle phalanges. Also noted was resorption of the middle portion of a few of the phalanges. As part of the work-up, further radiographs of the knee joints were performed, which showed sub-periosteal erosion along the superio-medial aspect of the tibiae. A hyperfunctioning parathyroid adenoma was also noted, for which surgery was performed.
Discussion
In acro-osteolysis there is loss of terminal tufts of the digits. No periosteal reaction is seen. Epiphyses, if involved, occur late in the disease. It is seen is various conditions including:
  • Scleroderma (associated with soft calcifications)
  • Psoriatic arthritis, associated with nail and skin deformities
  • Hyperparathyroidism, other findings include sub-periosteal resorption along the radial side of the middle phalanges
  • Cleidocranial dysostosis
  • Pyknodysostosis, along with aplasia/hypoplasia of the distal digits and seen in children
  • Polyvinylchloride exposure, workers with history of exposure
  • Progeria, premature ageing
  • Hajdu-Cheney Syndrome (familial idiopathic acro-osteolysis), rare syndrome and may be unilateral
  • Frostbite
  • Neuropathic, secondary to diabetes, syringomyelia etc
Leprosy, Lesch-Nyhan syndrome, epidermolysis bullosa and various other causes have also been described.

The patient in this case, in addition to hypercalcaemia, had other changes of hyperparathyroidism secondary to a parathyroid adenoma: sub-periosteal resorption seen at the proximal tibia bilaterally (Fig. 2) and along the radial aspect of the middle phalanges and resorption of the middle portion of the phalanges.

Differential Diagnosis List
Acro-osteolysis in hyperparathyroidism
Final Diagnosis
Acro-osteolysis in hyperparathyroidism
Case information
URL: https://www.eurorad.org/case/1834
DOI: 10.1594/EURORAD/CASE.1834
ISSN: 1563-4086
Figure 1

AP view of both hands with coned view of the distal phalanges

AP view of both hands with coned view of the distal phalanges
Resorption of the tufts of the terminal phalanges.
AP view of both hands with coned view of the distal phalanges
Coned down view of the distal phalanges, showing the resorption of the terminal tufts and subperiosteal resorption along the medial aspect of the middle phalanges.
Figure 2

AP view of both knee joints

AP view of both knee joints
Sub-periosteal resorption along the superio-medial aspect of the tibia.