Question

The salt and pepper pot appearance of the skull is seen in:

• A. Hyperparathyroidism
• B. Multiple myeloma
• C. Hyperthyroidism
• D. Pseudohyperparathyroidism

Hint:

A finely granular vault from diffuse bone resorption points to excess PTH.

Answer 1

The Correct Option is A

Step 1: The salt and pepper (pepper-pot) skull refers to multiple tiny radiolucent foci scattered through the skull vault, giving a granular speckled texture on X-ray. Step 2: This is caused by extensive subperiosteal and trabecular bone resorption with small cystic areas of osteopenia. The classic driver of this resorptive bone disease is excess parathyroid hormone. Step 3: Primary hyperparathyroidism therefore produces the salt and pepper skull as part of osteitis fibrosa cystica. Step 4: Multiple myeloma gives sharply defined punched-out (raindrop) lytic lesions, not a fine granular pattern, and is a common distractor. Hyperthyroidism causes osteoporosis but not this specific speckled vault, and pseudohyperparathyroidism is a resistance state with hypocalcaemia, not this resorptive skull. So the answer is hyperparathyroidism.