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Tertiary hyperparathyroidism
Related Subjects: |PTH Physiology |Calcium Physiology |Magnesium Physiology |Calcitonin |Hypocalcaemia |Hypercalcaemia |Hypomagnesaemia |Hypermagnesaemia |Primary Hyperparathyroidism |Familial hypocalciuric hypercalcaemia (FHH) |Sarcoidosis
📖 About
- Tertiary hyperparathyroidism develops after prolonged secondary hyperparathyroidism 🌀 (usually from chronic kidney disease, CKD).
- Due to parathyroid hyperplasia becoming autonomous → PTH secretion continues even after correction of hypocalcaemia.
- Biochemically characterised by hypercalcaemia ⬆️ (unlike secondary HPT, which is usually normo- or hypocalcaemic).
🩺 Clinical Features
- Occurs in the context of advanced CKD or post-renal transplant.
- Features of hypercalcaemia: "stones, bones, abdominal groans, and psychiatric moans" 🪨🦴😖.
- Bone disease (renal osteodystrophy), pruritus, muscle weakness.
- Vascular and soft-tissue calcification → cardiovascular risk 💔.
🔬 Investigations
- CKD markers: ⬆️ Urea and Creatinine.
- Biochemical profile:
- ⬆️ Calcium
- ⬆️ Phosphate
- ⬆️ Alkaline phosphatase (ALP)
- ⬆️ PTH (markedly elevated)
- ⬇️ 1,25(OH)₂ Vitamin D (impaired renal activation)
- Imaging: Sestamibi parathyroid scan (for localisation if considering surgery).
- DEXA scanning may show low bone density.
⚖️ Management
- 🎯 Definitive therapy → Parathyroidectomy (subtotal or total with autotransplantation).
- 💊 Cinacalcet (calcimimetic) useful for patients unsuitable for surgery or awaiting transplant.
- Vitamin D analogues (e.g. alfacalcidol, calcitriol) may help suppress PTH.
- Phosphate binders and dietary phosphate restriction to control ⬆️ phosphate.
- Conservative management may be considered in frail/elderly patients if hypercalcaemia is controlled medically.
📚 References
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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