FIGURE 89.3 Secondary hyperparathyroidism in a 12-year-old girl with chronic pyelonephritis There is moderate subperiosteal erosion on the radial side of the middle phalanges; note a lacy appearance of the periosteum and small-tuft erosion Subperiosteal bone resorption is the most significant radiologic finding in hyperparathyroidism; subperiosteal bone resorption and tuft erosion are seen in both primary and secondary hyperparathyroidism (Courtesy of Soroosh Mahboubi, MD, The Children’s Hospital of Philadelphia.) HYPOPARATHYROIDISM Goal of Treatment Treatment goals for children with hypoparathyroidism include addressing the clinical effects of hypocalcemia and to initiate treatment with vitamin D and calcium CLINICAL PEARLS AND PITFALLS