Advances in Diagnosis and Management of Secondary and Tertiary Hyperparathyroidism

Hyperparathyroidism is a common complication of end-stage renal disease (ESRD). Secondary hyperparathyroidism (HPT) is characterized by increased parathyroid hormone (PTH) levels in combination of hypocalcemia and hyperphosphatemia in the presence of ESRD. In tertiary HPT, patients have increased PTH levels, as well as hypercalcemia and hyperphosphatemia, due to a disturbed feedback system after prolonged period of secondary HPT. Diagnosis is established by the measurement of serum PTH, calcium, phosphate, and vitamin D concentrations multiple times over a longer period of time. Treatment options include vitamin D supplements, phosphate binders, calcimimetics, and parathyroidectomy