Fig. 23.62 Primary hyperparathyroidism: 'pepper pot' skull This lateral film shows the classical changes in the skull vault of primary hyperparathyroidism. Generalised skeletal demineralisation is reflected by diffuse porotic mottling of the calvarium giving a granular or ΓÇÿpepper potΓÇÖ appearance. The vascular grooves are poorly defined and there is absence of the lamina dura of the teeth. The latter appearance is, however, not specific because it may occur in other dimineralising disorders such as osteoporosis and osteomalacia. In some patients with primary hyperparathyroidism the dorsum sellae may be eroded and in those with polyglandular adenomatosis and an associated pituitary tumour there may be enlargement of the pituitary fossa.
