Highlights & Basics
- Secondary hyperparathyroidism (SHPT) is elevation of parathyroid hormone (PTH) secondary to hypocalcemia.
- PTH maintains calcium homeostasis by acting on the renal tubules, on calcium stores in the skeletal system, and indirectly on the gastrointestinal tract through activation of vitamin D and enteral absorption.
- The disease most frequently associated with SHPT is chronic kidney disease. However, the most common reason for SHPT is vitamin D deficiency. Inadequate vitamin D stores are common in older people, those with malabsorption syndromes, or those with limited exposure to sunlight.
- Management includes appropriate treatment of the underlying cause and vitamin D supplementation. Parathyroidectomy is infrequently required to remove irreversibly enlarged parathyroid glands in an effort to restore normal parathyroid physiology.
- Untreated, it can result in significant skeletal and cardiovascular complications, which contribute to overall morbidity and mortality.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl (2011). 2017 Jul;7(1):1-59.[Abstract][Full Text]
Holick MF, Binkley NC, Bischoff-Ferrari HA, et al; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30.[Abstract][Full Text]
Petranović Ovčariček P, Giovanella L, Carrió Gasset I, et al. The EANM practice guidelines for parathyroid imaging. Eur J Nucl Med Mol Imaging. 2021 Aug;48(9):2801-22.[Abstract][Full Text]
American College of Radiology. ACR appropriateness criteria: parathyroid adenoma. 2021 [internet publication].[Full Text]
National Institute for Health and Care Excellence. Chronic kidney disease: assessment and management. Nov 2021 [internet publication].[Full Text]
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