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Secondary hyperparathyroidism

Last reviewed: 12 Nov 2024
Last updated: 04 Apr 2024

Summary

Definition

History and exam

Key diagnostic factors

  • features of chronic kidney disease
  • features of underlying malabsorption syndrome
Full details

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
Full details

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
Full details

Diagnostic tests

1st tests to order

  • serum calcium
  • serum intact parathyroid hormone (iPTH)
  • serum creatinine
  • serum BUN
Full details

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
Full details

Treatment algorithm

ACUTE

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

Disclosures

AK declares that he has no competing interests.

Acknowledgements

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.

Disclosures

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

Taiwan

Disclosures

Not disclosed.

Victor Schneider, MD

Clinical Associate Professor of Medicine

Uniformed Health Services University of the Health Sciences

Bethesda

MD

Disclosures

VS declares that he has no competing interests.

  • Differentials

    • Primary hyperparathyroidism
    More Differentials
  • Guidelines

    • 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)
    More Guidelines
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