Secondary and Tertiary Hyperparathyroidism

Secondary hyperparathyroidism (SHPT) is characterized by an increase in PTH secretion in response to an external stimulus, most commonly kidney disease. Tertiary hyperparathyroidism (THPT) is characterized by autonomous hypersecretion of PTH after causes of SHPT have been corrected, often this is following renal transplant or long-term dialysis. Medical management is focused on suppression of PTH and improvement of bone histology with calcitriol. Parathyroidectomy focuses on reduction of production of PTH by debulking or resecting hyperfunctioning parathyroid tissue, thus lowering calcium and phosphate. Surgical examination of all four glands is mandatory in SHPT and THPT, and surgical resection may involve limited, subtotal, or complete resection with or without autotransplantation of parathyroid tissue.