Metabolic Complications of Secondary Hyperparathyroidism

Juan J. Sancho, MD ■ Antonio Sitges-Serra, MD

The term secondary hyperparathyroidism (SHPT) means that external factors stimulate the parathyroid glands to increase the production of parathyroid hormone (PTH) and eventually to develop hyperplastic or adenomatous overgrowth, or both.

The most common condition causing the parathyroid glands to grow is chronic renal failure (CRF). The often used term renal hyperparathyroidism reflects this fact. SHPT may develop, however, in a variety of conditions such as idiopathic hypercalciuria,1 hypermagnesuria, osteomalacia, rickets, malnutrition, or osteoporosis2 with low serum levels of 1,25-dihydroxyvitamin D3 (l,25-[OH]2D3, calcitriol).3 Hyperparathyroidism in psychiatric patients receiving long-term treatment with lithium is also associated with parathyroid hyperplasia.4

In this chapter, the pathogenesis of SHPT related to CRF, its metabolic complications, and its relationship with the clinical manifestations of CRF are reviewed.

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