Review Article

Tertiary Hyperparathyroidism: A Review of The Disease

Spyridon-Gerasimos Moschonas¹, Symeon Tournis²

1. Postgraduate Program “Metabolic Bone Diseases”, Medical School, National and Kapodistrian University of Athens, Greece
2. Laboratory for Research of the Musculoskeletal System (LRMS), Medical School, National and Kapodistrian University of Athens, “KAT’’ Hospital, Greece

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Keywords: Hypophosphatemic Rickets, Parathyroidectomy, Renal Osteodystrophy, Pseudohypoparathyroidism, Tertiary Hyperparathyroidism

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Abstract

Tertiary hyperparathyroidism represents a disease, which occurs as a complication usually in patients with chronic kidney disease and background of secondary hyperparathyroidism and less often in other conditions, such as hypophosphatemic rickets syndromes, pseudohypoparathyroidism, oncogenic osteomalacia and malabsorption syndromes. It is characterized by persistently elevated parathyroid hormone and calcium levels, as a result of reactive nodular hyperplasia of the parathyroid glands. It is manifested by a variety of clinical symptoms, affecting multiple systems and mainly the musculoskeletal. The pathological changes in bones, observed in tertiary hyperparathyroidism, can be a result of the increased parathyroid hormone levels in the blood, as well as of the metabolic disorders related to chronic kidney disease. The diagnosis of tertiary hyperparathyroidism is based on clinical and laboratory findings, while its treatment includes pharmaceutical as well as surgical methods. In this article there will be a reference in etiology, pathophysiology, clinical picture, diagnostic and therapeutical approach of tertiary hyperparathyroidism, aiming to the adequate management of such a patient case. There will also be a brief reference of some elements from the anatomy and physiology of the parathyroid glands, which are going to contribute to a better understanding of the pathophysiological changes that occur in the disease.

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