Tertiary hyperparathyroidism occurs in patients with chronic renal failure, increases with age and is higher in postmenopausal women. The incidental finding of asymptomatic PHPT in the older patient poses problems, and there is little guidance on how to manage them. In hyperparathyroidism, the plasma calcium level is rarely >3.00 mmol/L, but the ionised calcium is almost always elevated and is a more sensitive test. In secondary hyperparathyroidism (SHPT), the abnormality in the parathyroid glands is induced by a sustained hypocalcaemic stimulus and usually associated with parathyroid hyperplasia. Tertiary hyperparathyroidism occurs in patients with chronic renal failure. The chapter reviews hyperparathyroidism and the management.
KeywordsPrimary hyperparathyroidism Secondary hyperparathyroidism Tertiary hyperparathyroidism Parathyroid hormone
- 15.National Institute of Health Consensus Development Conference Panel NIH conference. Diagnosis and management of asymptomatic primary hyperparathyroidism: consensus development conference. Ann Intern Med. 1991; 110: 593–7.Google Scholar
- 24.Nakai K, Komaba H, Fukugawa M. Management of mineral and bone disorder in chronic kidney disease. quo vadis? Ther Apher Dial. 2009; Suppl 1 S2–6.Google Scholar
- 26.Texas Institute for reproductive Medicine and Endocrine. PA. http://wwwhormoneproblem.com/Parathyr.htm. accessed 3 8.2012.
- 28.Page C, Strunski V. Primary risk in total thyroidectomy for bilateral benign multinodular goitre: a report of 351surgical cases. L. Laryngol Otol. 2007;121:237–41.Google Scholar
- 30.Hypoparathyroidism. Prolonged QT initially may progress to ventricular fibrillation or heart block. Patient.co.uk. Hyperparathyroidism. http://www.Patient.co.uk/doctor/hypoparathyroidism-pro. Retrieved on 26 February 2015.
- 32.Hedbach GM, Odin AS. Cardiovascular disease, hypertension and renal failure in primary hyperparathyroidism. J Int Med. 2002; 251:478–483.Google Scholar
- 33.Nilsson IL, Yin L, Lundgren E, Rastad CJ, Ekbom A. Clinical prevalence of primary hyperparathyroidism in Europe-nationwide cohort analysis on mortality from non malignant causes. J Bone Miner Res. 2002; 17 Suppl 2:N63–74.Google Scholar