Hyperparathyroidism is classified as primary, secondary, or tertiary. Primary hyperparathyroidism is characterized by elevated parathyroid hormone (PTH) and hypercalcemia. Parathyroid adenoma is responsible for 80% of cases of primary hyperparathyroidism. Patients are typically asymptomatic but may present rarely with nephrolithiasis and fractures. Osteitis fibrosa cystica, once a hallmark of the disease, is now a rare occurrence. Primary hyperparathyroidism is associated with MEN I and II. Secondary hyperparathyroidism occurs in patients with renal insufficiency. Chronic renal failure leads to hyperphosphatemia, hypocalcemia, and impaired production of renal calcitriol resulting in increased secretion of PTH, elevated bone turnover, and renal osteodystrophy. Patients may experience bone pain and proximal muscle weakness with radiographic evidence of subperiosteal erosions. Tertiary hyperparathyroidism exists when secondary hyperparathyroidism leads to autonomously...
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