Secondary and Tertiary Hyperparathyroidism: When to Operate and When Not to!

Abstract

Chronic kidney disease-mineral and bone disease is a systemic disorder which is manifested by laboratory abnormalities of calcium, phosphorus or calcitropic hormones. It also involves the abnormalities in bone turnover, mineralization, volume, linear growth, vascular or soft tissue calcification. Secondary hyperparathyroidism is defined as adaptive parathyroid gland hyperplasia and increased production of PTH. Tertiary hyperparathyroidism is severe, persistent, and progressive elevation of serum parathyroid hormone (PTH) that cannot be treated adequately by medical therapy (including both vitamin D analogs and calcimimetics) without causing significant hyperphosphatemia or hypercalcemia.