Secondary Hyperparathyroidism

Background

• Secondary hyperparathyroidism is caused by a failure of calcium, phosphate, and vitamin D homeostatic mechanisms resulting in elevated parathyroid hormone levels. It is common in patients with chronic kidney disease (CKD), calcium malabsorption, or vitamin D deficiency.
• Secondary hyperparathyroidism has been reported in 1.2% of the healthy adult population. In patients with CKD, prevalence increases as the estimated glomerular filtration rate decreases.
• Complications, such as bone disease and cardiovascular problems, are increased in patients with secondary hyperparathyroidism, especially those with renal disease.

Evaluation

• Patients may be asymptomatic, with only biochemical or radiographic evidence of the disease. Typical laboratory findings include elevated parathyroid hormone with normal or hypocalcemia.
• Testing should include measurement of parathyroid hormone, serum calcium, creatinine, albumin, phosphate, alkaline phosphatase, and vitamin D levels.

Management

• Treat the underlying causes of secondary hyperparathyroidism.
• Provide adequate calcium and vitamin D supplementation.
• Options for medical management for those with CKD include
  • phosphate binders
  • calcium mimetics
  • vitamin D analogs
• Parathyroidectomy may be considered in certain patients with CKD, particularly those who do not respond to medical management within 1 year or those with severe complications (Weak Recommendation).