Secondary hyperparathyroidism

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Última revisão: 13 Oct 2025

Última atualização: 04 Apr 2024

Secondary hyperparathyroidism (SHPT) is elevation of parathyroid hormone (PTH) secondary to hypocalcemia.

PTH maintains calcium homeostasis by acting on the renal tubules, on calcium stores in the skeletal system, and indirectly on the gastrointestinal tract through activation of vitamin D and enteral absorption.

The disease most frequently associated with SHPT is chronic kidney disease. However, the most common reason for SHPT is vitamin D deficiency. Inadequate vitamin D stores are common in older people, those with malabsorption syndromes, or those with limited exposure to sunlight.

Management includes appropriate treatment of the underlying cause and vitamin D supplementation. Parathyroidectomy is infrequently required to remove irreversibly enlarged parathyroid glands in an effort to restore normal parathyroid physiology.

Untreated, it can result in significant skeletal and cardiovascular complications, which contribute to overall morbidity and mortality.

Definição

Any disorder that results in hypocalcemia will elevate PTH levels and can serve as a cause of SHPT. The most frequent causes are chronic kidney disease (CKD), malabsorption syndromes, and chronic inadequate sunlight exposure, acting via alterations in vitamin D, phosphorus, and calcium.

SHPT is a complication of CKD and is important in the pathogenesis of CKD-mineral bone disorder (MBD). CKD-MBD is defined as a systemic disorder of mineral and bone metabolism due to CKD manifested by either one or a combination of the following: abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism; abnormalities in bone turnover, mineralization, volume, linear growth, or strength; vascular or other soft-tissue calcification.[1]

História e exame físico

Principais fatores diagnósticos

features of chronic kidney disease
features of underlying malabsorption syndrome

Detalhes completos

Outros fatores diagnósticos

muscle cramps and bone pain
perioral tingling or paresthesia in fingers or toes
Chvostek sign
Trousseau sign
bowed legs or knock knees
fractures

Detalhes completos

Fatores de risco

aging
chronic kidney disease
vitamin D deficiency: inadequate sunlight exposure
nutritional deficiency (especially absence of dairy products and fish)
vitamin D deficiency: malabsorption
vitamin D deficiency: hepatic dysfunction
vitamin D deficiency: genetic disorder
vitamin D deficiency: obesity
medication use

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

serum calcium
serum intact parathyroid hormone (iPTH)
serum creatinine
serum BUN

Detalhes completos

Investigações a serem consideradas

serum phosphorus
serum 25-hydroxyvitamin D
serum magnesium
ultrasound neck
99Tc-sestamibi (MIBI) scan
high-resolution contrast CT scan neck and upper chest
MRI neck and upper chest

Detalhes completos

Algoritmo de tratamento

AGUDA

lack of sunlight

malabsorption-related

CKD stages 3 to 5D

Colaboradores

Autores

Syazrah Salam, MBChB, PhD, FRCP

Metabolic Bone and Nephrology Consultant

Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust

Declarações

SS declares that he has no competing interests.

Arif Khwaja, PhD, FRCP

Consultant Nephrologist

Sheffield Kidney Institute

Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust

Declarações

AK declares that he has no competing interests.

Agradecimentos

Dr Arif Khwaja and Dr Syazrah Salam would like to gratefully acknowledge Dr Hugh Gallagher, Dr Louise Ross, Dr Brendan C. Stack Jr, Dr David J.A. Goldsmith, and Dr Kiran Haresh Kumar Patel, previous contributors to this topic.

Declarações

HG, LR, BCS, DJAG, and KHKP declare that they have no competing interests.

Revisores

Fong-Fu Chou, MD

Department of Surgery

Chang Gung Memorial Hospital-Kaohsiung Medical Center

Chang Gung University College of Medicine

Kaohsiung Hsien

Taiwan

Declarações

Not disclosed.

Victor Schneider, MD

Clinical Associate Professor of Medicine

Uniformed Health Services University of the Health Sciences

Bethesda

Declarações

VS declares that he has no competing interests.

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Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl (2011). 2017 Jul;7(1):1-59.Texto completo Resumo

Holick MF, Binkley NC, Bischoff-Ferrari HA, et al; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30.Texto completo Resumo

Petranović Ovčariček P, Giovanella L, Carrió Gasset I, et al. The EANM practice guidelines for parathyroid imaging. Eur J Nucl Med Mol Imaging. 2021 Aug;48(9):2801-22.Texto completo Resumo

American College of Radiology. ACR appropriateness criteria: parathyroid adenoma. 2021 [internet publication].Texto completo

National Institute for Health and Care Excellence. Chronic kidney disease: assessment and management. Nov 2021 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Primary hyperparathyroidism
Mais Diagnósticos diferenciais
Diretrizes
- ACR appropriateness criteria: parathyroid adenoma
- KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD)
Mais Diretrizes
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Secondary hyperparathyroidism

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

lack of sunlight

malabsorption-related

CKD stages 3 to 5D

Colaboradores

Autores

Syazrah Salam, MBChB, PhD, FRCP

Declarações

Arif Khwaja, PhD, FRCP

Declarações

Agradecimentos

Declarações

Revisores

Fong-Fu Chou, MD

Declarações

Victor Schneider, MD

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice