What causes salt and pepper skull in the calvaria on skull radiograph?
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Answer:
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Salt and pepper skull represents multiple tiny lucent and sclerotic foci in the calvaria due to osteitis fibrosa cystica, a skeletal manifestation of hyperparathyroidism (primary, secondary, or tertiary).
Why is it called so?
The name derives from the radiographic appearance resembling a mixture of white salt grains (osteosclerotic areas) and black pepper granules (lytic areas) scattered throughout the calvarial bone.
Pathophysiology
Hyperparathyroidism elevates parathyroid hormone levels, stimulating excessive osteoclast-mediated trabecular bone resorption (producing lucent foci, or “pepper”) followed by reactive osteoblastic bone formation (producing sclerotic foci, or “salt”), resulting in a mixed salt-and-pepper pattern.
Alternative names: Pepper pot skull
Other associated named signs: Subperiosteal resorption, brown tumors, rugger jersey spine
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