What is the pathophysiology of tertiary hyperparathyroidism?

Updated: Dec 24, 2020
  • Author: Lawrence T Kim, MD, FACS, FACE; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Tertiary hyperparathyroidism is observed most commonly in patients with chronic secondary hyperparathyroidism who have been on dialysis therapy for years. The hypertrophied parathyroid glands enlarge over time and continue to oversecrete parathyroid hormone, despite serum calcium levels that are within the reference range or even elevated. In these cases, the hypertrophied glands become autonomic and cause hypercalcemia, even after withdrawal of calcium and active vitamin D therapy. They also may become resistant to calcimimetic treatment. [67, 68] This type of tertiary disease is particularly dangerous because the phosphate level is often elevated. If the calcium value multiplied by the phosphate value yields a high product, diffuse calcinosis may occur.

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