Secondary hyperparathyroidism (sHPT) is a condition that occurs when external factors stimulate the parathyroid glands to increase the secretion of parathyroid hormone (PTH), and develop mostly hyperplasia and/or adenomas of the parathyroid.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Silver J. Molecular mechanism of secondary hyperparathyroidism. Nephrol Dial Transplant. 2000;15(Suppl 5):S2–S7.
Drücke TB. The pathogenesis of parathyroid gland hyperplasia in chronic renal failure. Kidney Int. 1995;48:259–72.
Davies DR, Dent CE, Watson L. Tertiary hyperparathyroidism. BMJ. 1968;2:395–9.
Delmez JA, Slatopolsky E. Hyperphosphatemia: its consequences and treatment in patients with chronic renal disease. Am J Kidney Dis. 1992;19:303–17.
Llach F, Massry SG. On the mechanism of secondary hyperparathyroidism in moderate renal insufficiency. J Clin Endocrinol Metab. 1985;61:601–6.
Almaden Y, Hernandez A, Torregrosa V, et al. High phosphate level directly stimulates parathyroid hormone secretion and synthesis by human parathyroid tissue in vitro. J Am Soc Nephrol. 1998;9:1845–52.
Cozzolino M, Lu Y, Finch J, Slatopolsky E, et al. p21WAFa and TGF-alpha mediate parathyroid growth arrest by vitamin D and high calcium. Kidney Int. 2001;60:2109–17.
Rosenblatt M, Kronenberg H, PottsJ. Parathyroid hormone. Physiology, chemistry, biosynthesis, secretion, metabolism, and mode of action. In: Defroot LJ, editors. Endocrinology, 2nd ed. Philadelphia: WB Saunders, 1989. 848.
Malberti F, Corradi B, Pagliari B, et al. The igmoidal parathyroid hormone-ionized calcium curve and the set point of calcium in hemodialysis and continuous ambulatory peritoneal dialysis. Perit Dial Int. 1993;13:S476–9.
Fukagawa M, Kazama JJ. With or without the kidney: the role of FGF23 in CKD. Nephrol Dial Transplant. 2005;20:1295–8.
Tokumoto M, Taniguchi M, Matsuo D, et al. Parathyroid cell growth in patients with advanced secondary hyperparathyroidism: vitamin d receptor, calcium sensing receptor, and cell cycle regulating factors. Ther Apher Dial. 2005;9:S27–34.
Rodriguez M, Nemeth E, Martin D. The calcium-sensing receptor: a key role in the pathogenesis of secondary hyperparathyroidism. Am J Physiol Renal Physiol. 2005;288:F253–64.
Stein MS, Packham DK, Ebeling PR, et al. Prevalence and risk in dialysis patients. Am J Kidney Dis. 1996;28:515–22.
Pletka PG, Strom TB, Hampers CL, et al. Secondary hperparathyrodism in human kidney transplant recipients. Nephron. 1976;17:371–381.
Saha HH, Salmela KT, Ahonen PJ, et al. Sequential changes in vitamin D and calcium metabolism after successful renal transplantation. Scand J Urol Nephrol. 1994;28:21–7.
Christensen MS, Nielsen HE. The clinical significance of hyperparathyroidism after renal transplantation. Scand J Urol Nephrol. 1977;(Suppl 42):130–3.
Malluche HH, Faugere M-C. Atlas of Mineralized Bone Histology. Basel, Switzerland: Karger; 1986;17–24.
Malluche HH. Aluminium and bone disease m chronic renal failure. Nephrol Dial Transplant. 2002;17(Suppl 2):21–4.
Sherrard DJ. The role of aluminum in renal osteodystrophy. Mayo Clin Proc. 1993;68:510–1.
Chan ED, Morales DV, Welsh CH, et al. Calcium deposition with or without bone formation in the lung. Am J Respir Crit Care Med. 2002;165:1654–69.
Strozecki P, Adamowicz A, Nartowicz E, et al. Parathormon, calcium, phosphorus, and left ventricular structure and function in normotensive hemodialysis patients. Ren Fail. 2001;23:115–26.
Hara S, Ubara Y, Arizono K, et al. Relation between parathyroid hormone and cardiac function in longterm hemodialysis patients. Miner Electrolyte Metab. 1995;21: 72–6.
Vattikuti R, Towler DA. Osteogenic regulation of vascular calcification: an early perspective. Am J Physiol Endocrinol Metab. 2004;286:E686–96.
Guerin AP, London GM, Marchais SJ, et al. Arterial stiffening and vascular calcifications in end-stage renal disease. Nephrol Dial Transplant. 2000;15:1014–21.
Foley RN. Clinical epidemiology of cardiac disease in dialysis patients: left ventricular hypertrophy, ischemic heart disease, and cardiac failure. Semin Dial. 2003;16:111–17.
Nasri H, Baradaran A, Naderi AS. Close association between parathyroid hormone and left ventricular function and structure in end-stage renal failure patients under maintenance hemodialysis. Acta Med Austriaca. 2004;31:67–72.
Ketteler M, Bongartx P, Westenfeld R, et al. Association of low fetuin-A (AHSG) concentrations in serum with cardiovascular mortality in patients on dialysis: a cross-sectional study. Lancet. 2003;361:827–33.
Alfrey AC. The role of abnormal phosphorus metabolism in the progression of chronic kidney disease and metastatic calcification. Kidney Int. 2004;90(Suppl):S13–7.
Lingam RK, Teh J, Sharma A, Friedman E. Metastatic pulmonary calcification in renal failure: a new HRCT pattern. Brit J Radiol. 2002;75:74–7.
Hiroshige K, Kabashima N, Takasugi M, et al. Optimal dialysis improves uremic pruritus. Am J Kidney Dis. 1995;25:413–9.
Demeure MJ, McGee DC, Wilkes W, et al. Results of surgical treatment for hyperparathyroidism associated with renal disease. AM J Surg. 1990;160:337–40.
Duh QY, Lim RC, Clark OH. Calciphylaxis in secondary hyperparathyroidism. Diagnosis and parathyroidectomy. Arch Surg. 1991;126:1213–8; discussion 1218–9.
Schaffer C, Heiss A, Schwarz A, et al. The serum protein a2-Heremans-Schmid glycoprotein/fetuin-A is a systemically acting inhibitor of ectopic calcification. J Clin Invest. 2003;112:357–66.
Toorians AW, Janssen E, Laan E, et al. Chronic renal failure and sexual functioning: clinical status versus objectively assessed sexual response. Nephrol Dial Transplant. 1997;12:2654–63.
Eknoyan G, Levm A, Levin NW, for the National Kidney Foundation. Bone metabolism and disease m chronic kidney disease. Am J Kidney Dis. 2003;42:1–201.
Massry SG. Pathogenesis of the anemia of uremia: Role of secondary hyperparathyroidism. Kidney Int. 1983;16(Suppl):S204–7.
Rao DS, Shih MS, Mohini R. Effect of serum parathyroid hormone and bone marrow fibrosis on the response to erythropoietin in uremia. N Engl J Med. 1993;328:171–5.
Young EW, Albert JM, Satayathum S, et al. Predictors and consequence of altered mineral metabolism: the dialysis outcomes prac pattern study. Kidney Int. 2005;67:1179–87.
Onoda N, Kashiwagi T, Nakamura T, et al. Parathyroid interventions for secondary hyperparathyroidism in hemodialyzed patients. Ther Apher Dial. 2005;9:S11–5.
Indriason OS, Quarles LD. Comparison of treatments for mild secondary hyperparathyroidism in hemodialysis patients. Kidney Int. 2000;57:282–92.
Weber CK, Friedrich JM, Merkle E, et al. Reversible metastatic pulmonary calcification in a patient with multiple myeloma. Ann Hematol. 1996;72:329–32.
Roe SM, Graham LD, Brock WB, et al. Calciphylaxis: early recognition and management. Am Surg. 1994;60:81–6.
Park CW, Oh YS, Shin YS, et al. Intravenous calcitriol regresses myocardial hypertrophy in hemodialysis patients with secondary hyperparathyroidism. Am J Kidney Dis. 1999;33:73–81.
National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42:S1–202.
Tominaga Y. Uremic calciphylaxis syndrome: calcified uremic artheriolopathy. Int Med. 2001;40:1174–5.
Block GA, Hulbert-Shearon TE, Levin NW, et al. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J kidney Dis. 1998;31:607–17.
Medical Expert Group (Chair: Cannata-Andia JB, and Drueke TB). Clinical algorithms on renal osteodystrophy. Nephrol Dial Transplant. 2000;15(Suppl 5):39–57.
Tominaga Y, Matsuoka S, Sato T. Surgical indications and procedures of parathyroidectomy in patients with chronic kidney disease. Ther Apher Dial. 2005;9:44–7.
Tanaka Y, Tominaga Y, Funahashi H, et al. Preoperative localization studies in secondary hyperplasia. Acta Chir Austriaca Suppl. 1996;124:14–6.
Pasieka JL, Parsons LL A prospective surgical outcome study assessing the impact of parathyroidectomy on symptoms in patients with secondary and tertiary hyperparathyroidism. Surgery. 2000;128:531–9
Fletcher S, Kanagasundaram NS, Rayner HC, et al. Assessment of ultrasound guided percutaneous ethanol injection and parathyroidectomy in patients with tertiary hyperparathyroidism. Nephrol Dial Transplant. 1998;13:3111–7
Decker PA, Cohen EP, Doffek KM, et al. Subtotal parathyroidectomy in renal failure: still needed after all these years. World J Surg. 2001;25:708–12
D’Alessandro AM, Melzer JS, Pirsh KD, et al. Tertiary hyperparathyroidism after renal transplantation: operative indications. Surgery. 1989;106:1049–55.
Kinnaert P, Nagy N, Decister-Gervy C, et al. Peresistent hyperparathyroidism requiring surgical treatment after kidnely transplantation World J Surg. 2000;24:1391–5.
Kerby KD, Rue KW, Blair H, et al. Operative treatment of tertiary hyperparathyroidism A single-center experience. Ann surg. 1998;227(6):878–886.
Geis WP, Popovitzer MM, Corman JL, et al. The diagnosis and treatment of hyperparathyrodism after renal transplantation. Surg Gyecol Obster. 1973;137:997–1010.
David DS, Sakai S, Brennan BL, et al. Hypecalcemia after renal transplantation. N Eng J Med. 1973;289:398.
Tominaga Y, Katayama A, Sato T, et al. Re-operation is frequently required when parathyroid glands remain after initial parathyroidectomy for advanced secondary hyperparathyroidism in uraemic patients. Nephrol Dial Transplant. 2003;18(Suppl 3):65–70.
Takagi H, Tominaga Y, Uchida K, et al. Subtotal versus total parathyroidectomy with forearm autograft for secondary hyperparathyroidism in chronic renal failure. Ann Surg. 1984;200(1):18–23.
Neonakis E, Wheeler MH, Krishnan H, et al. Results of surgical treatment of renal hyperparathyroidism. Arch Surg. 1995;130:643–8.
Richards ML, Wormuth J, Bingener J, et al. Parathyroidectomy in secondary hyperparathyroidism: Is there an optimal operative management? Surgery. 2006;139:174–80.
Stracke S, Jehle PM, Sturm D, et al. Clinical course after total parathyroidectomy without autotransplantation in patients with end-stage renal failure. Am J Kidney Dis. 1999;33:304–11.
Al-Sobhi S, Clark OH. Parathyroid hyperplasia: parathyroidectomy. In Clark OH, Duh QY, editors. Textbook of endocrine surgery, 2nd edition. Philadelphia: WB Saunders, 2005.
Hampl H, Steinmuller T, Stabell U, et al. Recurrent hyperparathyroidism after total parathyroidectomy and autotransplantation in patients with long-term hemodialysis. Miner Electrolyte Metab. 1991;17:256–60.
Tominaga Y. Surgical management of secondary hyperparathyroidism in uremia. Am J Med Sci. 1999;317:390–7.
Saxe AW, Brennan MF. Reoperative parathyroid surgery for primary hyperparathyroidism caused by multiple-gland disease: total parathyroidectomy and autotransplantation with cryopreserved tissue. Surgery. 1982;91:616–21.
Chou FF, Lee CH, Chen JB, et al. Intraoperative parathyroid hormone measurement in patients with secondary hyperparathyroidectomy. Arch Surg. 2002;137:341–4.
Kebebew E, Duh QY, Clark OH. Tertiary hyperparathyroidism Histologic patterns of disease and results of parathyroidectomy Arch Surg. 2004;139:974–7
Triponez F, Kebebew E, Dossh D, et al. Less-than-subtotal parathyroidectomy increases the risk of persistent/recurrent hyperparathyroidism after parathyroidectomy in tertiary hyperparathyroidism after renal transplantation Surgery. 2006;140:990–9.
Kilgo MS, Pirsch JD, Warner TF, et al. Tertiary hyperparathyroidism after renal transplantation: surgical strategy. Surgery. 1998;124:677–84.
Thanasoulis L, Bingerner J, Sirinek K, et al. A successful application of the intraoperative parathyroid hormone assay in tertiary hyperparathyroidism Am Surg. 2007;73:281–3.
Nichol PF, Mack E, Bianco J, et al. Radioguided parathyroidectomy in patients with secondary and tertiary hyperparathyroidism. Surgery. 2003;134:713–9.
Walgenbach S, Junginger T. Intraoperative parathyroid hormone monitoring in neck exploration for renal hyperparathyroidism? Chirurg. 2002;73: 211–6.
Clary BM, Garner SC, Leight GS Jr. Intraoperative parathyroid hormone monitoring during parathyroidectomy for secondary hyperparathyroidism. Surgery. 1997;122:1034–8.
Yamashita H, Noguchi S, Futata T, et al. Usefulness of quick intraoperative measurements of intact parathyroid hormone in the surgical management of hyperparathyroidism. Biomed Pharmacother. 2000;54(Suppl 1): 108–11.
Tanaka M, Itoh K, Matsushita K, et al. Efficacy of percutaneous ethanol injection therapy for secondary hyperparathyroidism in patients on hemodialysis as evaluated by parathyroid hormone levels according to K/DOQI guidelines. Ther Apher Dial 2005;9:48–52.
Shiizaki K, Negi S, Hatamura I, et al. Biochemical and cellular effects of direct maxacalcitol injection into parathyroid gland in uremic rats. J Am Soc Nephrol. 2005;16:97–108.
Cattan P, Halimi B, Aidan K, et al. Reoperation for secondary uremic hyperparathyroidism: are technical difficulties influenced by initial surgical procedure? Surgery. 2000;127(5):620–25.
Tominaga Y. Surgical treatment of secondary hyperparathyroidism due to chronic kidney disease. Ups J Med Sci. 2006;111:277–92.
Kestenbaum B, Andress DL, Schwartz SM, et al. Survival following parathyroidectomy among United States dialysis patients. Kidney Int. 2004;66:2010–6.
Gagne ER, Urena P, Leite-Silva S, et al. Short- and long-term efficacy of total parathyroidectomy with immediate autografting compared with subtotal parathyroidectomy in hemodialysis patients. J Am Soc Nephrol. 1992;3:1008–17.
Coen G, Calabria S, Bellinghieri G, et al. Parathyroidectomy in chronic renal failure: short- and long-term results on parathyroid function, blood pressure and anemia. Nephron. 2001;88:149–55.
Takagi H, Tominaga Y, Tanaka Y, et al. Total parathyroidectomy with forearm autograft for secondary hyperparathyroidism in chronic renal failure. Ann Surg. 1988;208:639–44.
Kinnaert P, Salmon I, Deoster-Gervy C, et al. Long-term results of subcutaneous parathyroid grafts in uremic patients. Arch Surg. 2000;135:186–90.
Henry JF, Denizot A, Audiffret J, et al. Results of reoperations for persistent or recurrent secondary hyperparathyroidism in hemodialysis patients. World J Surg. 1990;14:303–6.
Kinnaert P, Nagy N, Decoster-Gervy C, et al. Persistent hyperparathyroidism requiring surgical treatment after kidney transplantation. World J Surg. 2000;24:1391–5.
De Francisco AL, Amado JA, Casanova D, et al. Recurrence of hyperparathyroidism after total parathyroidectomy with autotransplantation: a new technique to localize source of hormone excess. Nephron. 1991;58:306–9.
Yajima A, Ogawa Y, Takahashi HE, et al. Changes of bone remodeling immediately after parathyroidectomy for secondary hyperparathyroidism. Am J Kidney dis. 2003;42:729–38.
Yano S, Sugimoto T, Tsukamoto T, et al. Effect of parathyroidectomy on bone mineral density in hemodialysis patients with secondary hyperparathyroidism: possible usefulness of preoperative determination of parathyroid hormone level for prediction of bone regain. Horm Metab Res. 2003;35:259–64.
Chou FF, Chen JB, Lee Ch, et al. Parathyroidectomy can improved bone mineral density in patients with symptomatic secondary hyperparathyroidism in dialysis patients: recommendation for a change in management. Am J Kidney Dis. 2000;35:1226–37.
Goldsmith DJ, Covic AA, Venning MC, et al. Blood pressure reduction after parathyroidectomy for secondary hyperparathyroidism: further evidence implicating calcium homeostasis in blood pressure regulation. Am J Kidney Dis. 1996;27:819–25.
Zingraff J, Drueke T, Marie P, et al. Anemia and secondary hyperparathyroidism Arch Interm Med. 1978;138(11):1650–2
Brancaccio D, Cozzolino M, Gallieni M. Hyperparathyroidism and anemia in uremic subjects : a combined therapeutic approach. J Am Soc Nephrol. 2004;15:S21–4
Ifudu O, Matthew JJ, Macey LJ, Hong JS, Sumrani N, Sommer BG, Friedman EA. Parathyroidectomy does not correct hypertension in patients on maintenance hemodialysis. Am J Nephrol. 1998;18:28–34.
Parfitt AM. Soft-tissue calcification in uremia. Arch Intern Med. 1969;124:544–56.
Bleyer AJ, Burkart J, Piazza M, et al. Changes in cardiovascular calcification after parathyroidectomy in patients with ESRD. Am J Kidney Dis. 2005;46:464–9.
De Francisco AM, Ellis HA, Owen JP, et al. Parathyroidectomy in chronic renal failure. Q J Med. 1985;55:289–315.
Goto N, Tominaga Y, Matsuoka S, et al. Cardiovascular complications caused advanced secondary hyperparathyroidism in chronic dialysis patients; special focus on dilated cardiomyopathy. Clin Exp Nephrol. 2005;9:138–41.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Springer-Verlag London Limited
About this chapter
Cite this chapter
Chen, JY., Tseng, LM., Lee, CH. (2009). Management of Secondary and Tertiary Hyperparathyroidism. In: Hubbard, J., Inabnet, W., Lo, CY. (eds) Endocrine Surgery. Springer Specialist Surgery Series. Springer, London. https://doi.org/10.1007/978-1-84628-881-4_22
Download citation
DOI: https://doi.org/10.1007/978-1-84628-881-4_22
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-84628-880-7
Online ISBN: 978-1-84628-881-4
eBook Packages: MedicineMedicine (R0)