Secondary hyperparathyroidism
Summary
Definition
History and exam
Key diagnostic factors
- features of chronic kidney disease
- features of underlying malabsorption syndrome
Other diagnostic factors
- muscle cramps and bone pain
- perioral tingling or paresthesia in fingers or toes
- Chvostek sign
- Trousseau sign
- bowed legs or knock knees
- fractures
Risk factors
- 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
Diagnostic tests
1st tests to order
- serum calcium
- serum intact parathyroid hormone (iPTH)
- serum creatinine
- serum BUN
Tests to consider
- 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
Treatment algorithm
lack of sunlight
malabsorption-related
CKD stages 3 to 5D
Contributors
Authors
Syazrah Salam, MBChB, PhD, FRCP
Metabolic Bone and Nephrology Consultant
Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust
UK
Disclosures
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
UK
利益声明
AK declares that he has no competing interests.
鸣谢
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.
利益声明
HG, LR, BCS, DJAG, and KHKP declare that they have no competing interests.
同行评议者
Fong-Fu Chou, MD
Department of Surgery
Chang Gung Memorial Hospital-Kaohsiung Medical Center
Chang Gung University College of Medicine
Kaohsiung Hsien
Taiwan
利益声明
Not disclosed.
Victor Schneider, MD
Clinical Associate Professor of Medicine
Uniformed Health Services University of the Health Sciences
Bethesda
MD
利益声明
VS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
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.全文 摘要
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.全文 摘要
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.全文 摘要
American College of Radiology. ACR appropriateness criteria: parathyroid adenoma. 2021 [internet publication].全文
National Institute for Health and Care Excellence. Chronic kidney disease: assessment and management. Nov 2021 [internet publication].全文
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Primary hyperparathyroidism
更多 鉴别诊断指南
- 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)
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