Tertiary hyperparathyroidism

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Tertiary hyperparathyroidism
Synonyms
Pronounce	N/A
Specialty	N/A
Symptoms	Hypercalcemia, bone pain, kidney stones, osteoporosis
Complications	Cardiovascular disease, osteitis fibrosa cystica
Onset
Duration
Types
Causes	Chronic kidney disease
Risks
Diagnosis	Blood test (elevated parathyroid hormone and calcium levels)
Differential diagnosis	Primary hyperparathyroidism, secondary hyperparathyroidism
Prevention
Treatment	Parathyroidectomy, medication
Medication	Calcimimetics, vitamin D analogs
Prognosis
Frequency
Deaths

X-ray of periosteal reaction in renal osteodystrophy

Calcium regulation in the body

Parathyroid hormone negative feedback loop

Parathyroid hyperplasia - low magnification

Parathyroid hyperplasia - intermediate magnification

Parathyroid hyperplasia - high magnification

Tertiary Hyperparathyroidism is a medical condition characterized by the excessive secretion of parathyroid hormone (PTH) from the parathyroid glands, even after the correction of the long-standing hypercalcemia that is typically associated with secondary hyperparathyroidism. This condition is most commonly seen in patients with chronic kidney disease who have undergone dialysis for a prolonged period.

Etiology

Tertiary hyperparathyroidism develops as a result of long-standing secondary hyperparathyroidism. The continuous stimulation of the parathyroid glands due to low calcium levels in secondary hyperparathyroidism can lead to nodular hyperplasia, a condition where the parathyroid glands enlarge and produce excessive amounts of PTH, even when the calcium levels return to normal.

Clinical Presentation

Patients with tertiary hyperparathyroidism may present with symptoms of hypercalcemia, such as polyuria, polydipsia, nephrolithiasis, bone pain, and fractures. Neurological symptoms such as depression, fatigue, and memory loss may also be present.

Diagnosis

The diagnosis of tertiary hyperparathyroidism is made based on the clinical history, physical examination, and laboratory findings. The hallmark of this condition is the presence of high levels of both PTH and calcium in the blood. Imaging studies such as ultrasound of the neck and scintigraphy can be used to identify the enlarged parathyroid glands.

Treatment

The primary treatment for tertiary hyperparathyroidism is parathyroidectomy, the surgical removal of the parathyroid glands. This procedure is usually performed when the patient has severe symptoms or when the hypercalcemia is not responsive to medical management. Following surgery, patients may require lifelong supplementation with calcium and vitamin D.

Prognosis

The prognosis for tertiary hyperparathyroidism is generally good with appropriate treatment. However, if left untreated, the condition can lead to serious complications such as osteoporosis, kidney stones, and cardiovascular disease.

See Also

• Primary Hyperparathyroidism
• Secondary Hyperparathyroidism
• Hypercalcemia
• Parathyroidectomy

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