By Victor Parsons

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Hyperparathyroidism is the most common cause of nephrocalcinosis which is visible radiologically in about 15 per cent of cases (177). Bone changes are the second most common presentation. The earliest change is demineralisa- 176 Hyperparathyroidism tion which is difficult to detect radiologically. The phalanges may show subperiosteal erosions (178) and even distal fracture. Loss of bone density in the skull is seen as a characteristic punctate loss of density, 'pepper pot skull'. After long continued parathyroid activity, the bone changes of osteitis fibrosa cystica (von Recklinghausen's disease of bone) may be seen as 'brown tumours' expanding the ribs (179) and jaw (180).

J .. ~ . /. · : .. J ~ . ~. ~.. ). ~. '-;·~ -. \ I:\ \ j -7 .. ~ . 1. c . ,,~. ': ' ,,- . 152 Paget's ) ~ .. ,. . \ disease - mosaic cement . ~-~ . ,. ~- ,'" lines The skull when affected is grossly thickened and the sutures are obliterated (156). Occasionally at an early stage of the disease an area may be so rarefied as to suggest a bony defect (osteoporosis circumscripta 157). Thickening of the skull may 50 153 Paget's disease - osteoblastic activity -. ,"'~" ,;-. 154 I'aget's bone resorption has been followed by deposition of new bone.

Osteoporosis, clinical features shown in 110 d. Paget's disease of bone, clinical features shown in III e. With the introduction of haemodialysis in the 110 Osteoporosis - clinical treatment of chronic renal failure, renal osteodystrophy has become increasingly important. It has features of osteomalacia, hyperparathyroidism, osteoporosis and osteosclerosis III Paget's disease of bone features - clinical features rarely dementia osteoporosis circumscripta deafness and other cranial nerve disorders painful corrugated cervical cord lesions ervical spine compression horacic loss of vertebral height hypercementosis thyroid disorders spine compression ncreased vessel calcification ribs rubbing on iliac crest heart failure and block associated PXE cord compression coxa vara multiple collapse creases vascular calc,ification thin skin McConkey's sign degenerative disease skull platybasia and midbrain lesions femoral fractures and bleeding hip sarcoma fibular fractures metatarsal fractures PXE = pseudoxanthoma elasticum a.

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