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23rd May 2025
Tertiary hyperparathyroidism
Tertiary hyperparathyroidism occurs after a longstanding state of secondary hyperparathyroidism. The parathyroid gland may become hypertrophied leading to autonomous hypersecretion of parathyroid hormone. It is mostly seen in patients who have chronic secondary hyperparathyroidism and have been on dialysis for years. This leads to hypercalcaemia and very high parathyroid hormone levels.
Presentation
- Symptoms of hypercalcaemia
Investigations
- Bone profile: may show hypercalcaemia and hyperphosphataemia
- Elevated urea and creatinine as seen in CKD are seen on blood tests.
Treatment
Medical management is usually with Cinacalet. Surgical treatment involves a total parathyroidectomy.
Summary
| Main Causes | Calcium | Parathyroid hormone | Phosphate | |
| Primary hyperparathyroidism | Parathyroid adenoma | High | High/Normal | Low |
| Secondary hyperparathyroidism | CKD Vitamin D deficiency | Low/Normal | High | High/Low |
| Tertiary hyperparathyroidism | Hypertrophied parathyroid gland due to long standing secondary hyperparathyroidism | High | Very High | High |
Table 1: Summary
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