Secondary and tertiary hyperparathyroidism

Secondary hyperparathyroidism typically occurs as a result of vitamin D deficiency—parathyroid hormone release is increased as a secondary response to the low serum 25-hydroxyvitamin D concentration. Secondary elevation of parathyroid hormone can also occur in patients with chronic kidney disease. Management includes treatment of the underlying cause, and vitamin D supplementation if the patient is deficient.

Tertiary hyperparathyroidism is uncommon. The mechanism appears to be related to prolonged parathyroid stimulation (secondary hyperparathyroidism) leading to an autonomous parathyroid response, which produces hypercalcaemia. The most common causes are chronic kidney disease and kidney transplantation. Management often requires partial removal of the parathyroid glands (see Perioperative care for parathyroid surgery). Cinacalcet can be used with specialist advice to treat tertiary hyperparathyroidism in patients with chronic kidney disease¹.