Hyperparathyroidism vs Arteriovenous Fistula as Cause of 'Clubbing'

Abstract

To the Editor.— Drs Leb and Sharma (240:142, 1978) report clubbing in a patient receiving long-term hemodialysis and propose that it is related to the arteriovenous fistula. The photograph and the roentgenogram illustrate changes characteristic, if not pathognomonic, of hyperparathyroidism. Clubbing results from loss of supporting bone of the terminal phalanges, with resultant collapse of the soft tissues. Although most noticeable in the first three digits, the erosion of the tuft of the distal phalanx of the fourth digit is also apparent. Typically, the changes due to hyperparathyroidism are most marked in the radial digits and along the radial aspects of the phalanges. The photograph on p 738 of Williams's Textbook of Endocrinology 1 illustrates the relative sparing of the ulnar digits in a patient with hyperparathyroidism, similar to that in the case described by Leb and Sharma. I submit that the clubbing in that case was due to hyperparathyroidism, not