Scribd
Upload
29 views

Metabolic Conditions Didc Class

This document summarizes several metabolic bone conditions: 1) Paget's disease causes abnormal bone remodeling leading to bone deformity and pain. It typically affects older adults and sites like the pelvis, skull, and jaws. Radiographs show a cotton-wool appearance from bone sclerosis. 2) Hyperparathyroidism is often due to a parathyroid adenoma and causes high calcium levels, leading to symptoms like weakness and bone pain. It can cause loosening of teeth. 3) Acromegaly is due to excess growth hormone from a pituitary adenoma. It causes coarse facial features, joint pain, and oral changes like enlarged jaws and separation of teeth.

Uploaded by

Siddique Saand
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
29 views

Metabolic Conditions Didc Class

This document summarizes several metabolic bone conditions: 1) Paget's disease causes abnormal bone remodeling leading to bone deformity and pain. It typically affects older adults and sites like the pelvis, skull, and jaws. Radiographs show a cotton-wool appearance from bone sclerosis. 2) Hyperparathyroidism is often due to a parathyroid adenoma and causes high calcium levels, leading to symptoms like weakness and bone pain. It can cause loosening of teeth. 3) Acromegaly is due to excess growth hormone from a pituitary adenoma. It causes coarse facial features, joint pain, and oral changes like enlarged jaws and separation of teeth.

Uploaded by

Siddique Saand
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 14

METABOLIC CONDITIONS

DR RAMSHA AZHAR
PAGET’S DISEASE
(Fig 15.1A, Fig 15.2, Fig 15.4, Fig 15.5)
ETIOLOGY:

• Unknown, theories include infection by


paramyxovirus and mutations in several genes
that are involved in osteoclastogenesis
CLINICAL FEATURES:
•Occur in patients older than 50 years
•Most common sites of involvement include the pelvis, skull, tibia,
vertebrae, humerus, and sternum
•In 20% of patients, jaws are affected; maxilla is involved twice as
often as the mandible
•Symptoms include bone deformity; deep, aching bone pain; elevated
skin temperature over the affected bone .
•Neurologic complaints— including headache, auditory or visual
disturbances, facial paralysis, vertigo, and weakness
•When teeth are present, increased spacing, as well as loosening, is
noted.
•In severe cases, continued enlargement of the maxilla or mandible can
make closure of the lips difficult or impossible.
RADIOGRAPHIC FEATURES:

• Late stage of Paget’s disease are due to bony sclerosis


providing a patchy radiopaque pattern described as
resembling cotton or wool.
• In the jaws, this pattern of bone change may be
associated with hypercementosis or resorption of
tooth roots, loss of lamina dura, and obliteration of
the periodontal ligament space.
HISTOLOGICAL FEATURES:

• In the initial resorptive phase, random overactive osteoclastic


bone resorption is evident.
• Resorbed bone is replaced by vascularized connective tissue
in company with prominent osteolysis and osteogenesis.
• Bone eventually develops a dense mosaic pattern as a result
of reversal lines in increasingly sclerotic bone, as osteoclasts
give way to osteoblasts.
• Serum calcium and serum phosphate levels are normal in the
presence of markedly elevated alkaline phosphatase levels.
HYPERPARATHYROIDISM
(Fig 15.8A)
ETIOLOGY:

• Primary hyperparathyroidism is characterized by


hypersecretion of parathyroid hormone from one or more
hyperplastic parathyroid glands (3%), a parathyroid adenoma
(90%), or, less commonly, an adenocarcinoma (3%).
• Secondary hyperparathyroidism occurs as a compensatory
response to hypocalcemia, as may be found in renal failure, in
patients undergoing renal dialysis, and in those with intestinal
malabsorption syndromes.
CLINICAL FEATURES:
• Incidence increases with age; greater in postmenopausal women.
• Early symptoms include fatigue, weakness, nausea, anorexia,
arrhythmias, polyuria, thirst, depression, and constipation.
• Bone pain and headaches are often reported.
• Lesions of the kidneys, skeletal system, gastrointestinal tract,
and nervous system are responsible for this syndrome complex.
• Loosening of the teeth may occur due to cortical thinning.
Pulpal obliteration, with complete calcification of the pulp
chamber and canals, has been reported in association with
secondary hyperparathyroidism.
HISTOPATHOLOGICAL FEATURES:
• The bony trabeculae exhibit osteoclastic resorption, as well as
the formation of osteoid trabeculae by large numbers of
osteoblasts.
• In these areas, a delicate fibrocellular stroma contains
numerous multinucleated giant cells.
• Accumulations of hemosiderin and extravasated red blood
cells are noted. As a result, the tissues may appear reddish
brown, accounting for the term brown tumor.
• The lesions are microscopically identical to central giant cell
granulomas.
RADIOGRAPHICAL FEATURES:

• Severe osseous changes (called, in the past, osteitis


fibrosa cystica) are the result of significant bone
demineralization, with fibrous replacement producing
radiographic changes that appear cystlike.
ACROMEGALY
(Fig 15.9 A, B & C)
ETIOLOGY:
• Hypersecretion of growth hormone from a
benign pituitary adenoma, subsequent to
epiphyseal closure.
CLINICAL FEATURES:
• Most often in the fourth decade
• No gender, racial or geographic predominance
• Insidious onset, and diagnosis is often delayed for many years.
• Affected individuals present with hyperhidrosis; coarse body hair; muscle
weakness; paresthesia; dysmenorrhea;
• In the facial bones and the jawbones, new periosteal bone formation,
cartilaginous hyperplasia and ossification is seen.
• Resultant orofacial changes include frontal bossing, nasal bone hypertrophy,
enlargement of the paranasal sinuses and secondary laryngeal hypertrophy,
produces deep, resonant voice.
• Oral manifestations include enlargement of the mandible and maxilla, with
secondary separation of teeth resulting from alveolar overgrowth; complete
posterior cross-bite; thickened oral mucosa; increased salivary gland tissue;
macroglossia; prominent lips

You might also like