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Secondary hyperparathyroidism

Last reviewed: 30 Oct 2023
Last updated: 27 Aug 2021



History and exam

Key diagnostic factors

  • features of chronic kidney disease
  • features of underlying malabsorption syndrome
More key diagnostic factors

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
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • serum calcium
  • serum intact parathyroid hormone (iPTH)
  • serum creatinine
  • serum BUN
More 1st investigations to order

Investigations to consider

  • serum phosphorus
  • serum 25-hydroxyvitamin D
  • serum magnesium
  • ultrasound neck
  • sestamibi scan
  • high-resolution contrast CT scan neck and upper chest
  • MRI neck and upper chest
More investigations to consider

Treatment algorithm


lack of sunlight


CKD stages 3 to 5D



Arif Khwaja, PhD FRCP

Consultant Nephrologist

Sheffield Kidney Institute

Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust



AK declares that he has no competing interests.

Syazrah Salam, MBChB MRCP PhD

Renal Registrar

Sheffield Kidney Institute

Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust



SS has received a research grant from Immunodiagnostic Systems via the University of Sheffield. SS is an author of an article cited in this topic.


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.


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

Peer reviewers

Fong-Fu Chou, MD

Department of Surgery

Chang Gung Memorial Hospital-Kaohsiung Medical Center

Chang Gung University College of Medicine

Kaohsiung Hsien



Not disclosed.

Victor Schneider, MD

Clinical Associate Professor of Medicine

Uniformed Health Services University of the Health Sciences




VS declares that he has no competing interests.

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