A. Magnified x-ray of index finger on fine-grain industrial film showing classic subperiosteal resorption in a patient with severe primary hyperparathyroidism.

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A. Magnified x-ray of index finger on fine-grain industrial film showing classic subperiosteal resorption in a patient with severe primary hyperparathyroidism. Note the left (radial) surface of the distal phalanx, where the cortex is almost completely resorbed, leaving only fine wisps of cortical bone. B. Skull x-ray from a patient with severe secondary hyperparathyroidism due to end-stage renal disease. Extensive areas of demineralization alternate with areas of increased bone density, resulting in the “salt and pepper” skull x-ray. (Used with permission from Dr. Harry Genant.) Source: Metabolic Bone Disease, Greenspan's Basic & Clinical Endocrinology, 10e Citation: Gardner DG, Shoback D. Greenspan's Basic & Clinical Endocrinology, 10e; 2017 Available at: https://accessmedicine.mhmedical.com/DownloadImage.aspx?image=/data/books/2178/gardgreen10_ch08_f015b-1.png&sec=166248891&BookID=2178&ChapterSecID=166248750&imagename= Accessed: November 06, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved