Secondary hyperparathyroidism
Secondary hyperparathyroidism
Updated: 02/08/2024
© Jun Wang, MD, PhD
General
features
- Overproduction of parathyroid hormone
- Secondary to a chronic abnormal stimulus, such as chronic hypocalcemia
- Bone changes similar by less severe than primary hyperparathyroidism
Risk
factors
- Renal failure (phosphorus retention causes hypocalcemia)
- Inadequate calcium intake
- Steatorrhea (failure to absorb Vitamin D)
- Vitamin D deficiency or resistance
Clinical
presentations
- Presentation of underlying disorders
- Multiple glands hyperplasia
Key
pathogenesis
- Chronic low calcium level due to conditions, such as renal failure
- Chronic phosphate retention causes excess FGF23 secretion
- FGF23 reduces renal 1,25(OH)2D production
- Low calcium and high phosphate stimulate PTH secretion and parathyroid proliferation
- Here is a video explaining this clearly.
Key laboratory findings
- Abnormalities of underlying disorder, such as abnormal renal function test
- Elevated levels of PTH
- High serum phosphorus
- Normal or low levels of calcium
- Low 1,25(OH)2D
Treatment
- Treat underlying disorders
- Correcting vitamin D deficiency, phosphate restriction
- Calcium supplementation, etc
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