Secondary (Renal) and Tertiary Hyperparathyroidism

What is Secondary Hyperparathyroidism?

Illustration showing rear view of thyroid and parathyroid glands

In secondary hyperparathyroidism, something in the body is causing the parathyroid glands to produce extra PTH. The glands are actually doing what they are supposed to do. If the problem elsewhere in the body can be corrected, the parathyroid glands go back to functioning normally. Secondary hyperparathyroidism caused by deficiency of Vitamin D is easily treated with medication and does not require surgery. Secondary hyperparathyroidism due to renal failure can often be controlled with a medication called cinacalcet. When patients have been on dialysis for many years or cincalcet is unable to control PTH production, the PTH levels can be extremely high and may require parathyroid surgery. All four parathyroid glands are involved in this disease process.

In addition to symptoms seen with primary hyperparathyroidism, other signs, symptoms and complications of secondary hyperparathyroidism can develop, including:

  • Bone deformities, fractures, and decreased bone density
  • Calcium deposition in the fat
  • Severe itching of the skin
  • Open non-healing wounds

Severe secondary hyperparathyroidism can lead to calciphylaxis which is a life threatening condition. Calciphylaxis can lead to soft-tissue wounds that won't heal until the hyperparathyroidism is controlled. Chronic non-healing wounds can lead to widespread infection (sepsis) and death.

What Is Tertiary Hyperparathyroidism?

In many patients who have undergone kidney transplants, parathyroid function returns to normal. In some patients, the parathyroid glands have functioned abnormally for so long while patients have kidney failure and are on dialysis, that parathyroid gland function never returns to normal. It is critically important to protect the transplanted kidney from any negative effects excess parathyroid hormone may have on the kidney (kidney stones, decreased function, dehydration that often accompanies high calcium levels). Patients with tertiary hyperparathyroidism are usually referred for parathyroid surgery.