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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