Salt and pepper appearance of the skull on Xray is seen in:

Salt and pepper appearance of skull is a radiologic feature of hyperparathyroidism. This appearance is due to resorption of the trabecular bone in the skull and replacement of the resorbed bone by a newly formed connective tissue causing loss of integrity in the shape of skull bones. Other radiologic features of hyperparathyroidism includes: Brown tumors: These are focal areas of bone resorption where the bone has been replaced by fibrous tissue and osteoclasts. In the spine, appearance of horizontal bands of sclerosis in the veebral bodies adjacent to the veebral end plates result in Rugger Jersey spine appearance. Chondrocalcinosis or calcification of the cailage Subperiosteal bone resorption characteristically involving radial side of the middle phalanx of the middle finger, medial proximal tibia and lateral end of clavicle. Ref: Radiological Differential Diagnosis By Bhargava page 59. Skeletal Radiology: The Bare Bones By Felix S. Chew page 282. Internal Medicine: An Illustrated Radiological Guide edited by Jarrah Ali Al-Tubaikh page 206.