Secondary and tertiary hyperparathyroidism

J Clin Densitom. 2013 Jan-Mar;16(1):64-8. doi: 10.1016/j.jocd.2012.11.012. Epub 2012 Dec 23.


We reviewed the etiology and management of secondary and tertiary hyperparathyroidism. Secondary hyperparathyroidism is characterized by an increase in parathyroid hormone (PTH) that is appropriate and in response to a stimulus, most commonly low serum calcium. In secondary hyperparathyroidism, the serum calcium is normal and the PTH level is elevated. Tertiary hyperparathyroidism is characterized by excessive secretion of PTH after longstanding secondary hyperparathyroidism, in which hypercalcemia has ensued. Tertiary hyperparathyroidism typically occurs in men and women with chronic kidney disease usually after kidney transplant. The etiology and treatment of secondary hyperparathyroidism is relatively straightforward whereas data on the management of tertiary hyperparathyroidism is limited to a few small trials with short follow-up.

Publication types

  • Review

MeSH terms

  • Calcimimetic Agents / therapeutic use
  • Female
  • Humans
  • Hyperparathyroidism* / classification
  • Hyperparathyroidism* / diagnosis
  • Hyperparathyroidism* / drug therapy
  • Hyperparathyroidism* / etiology
  • Hyperparathyroidism* / therapy
  • Hyperparathyroidism, Secondary / drug therapy
  • Hyperparathyroidism, Secondary / etiology
  • Hyperparathyroidism, Secondary / physiopathology
  • Hyperplasia
  • Kidney Transplantation
  • Male
  • Parathyroid Glands / pathology
  • Parathyroid Hormone / metabolism
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / metabolism


  • Calcimimetic Agents
  • Parathyroid Hormone