[Patient with chronic kidney disease and primary or tertiary hyperparathyroidism--case report]

Primary hyperparathyroidism (PHPT) is a clinical state of excessive parathyroid hormone (PTH) secretion. The clinical profile of PHPT depends on duration of disease, PTH concentration, hypercalcemia and coexisting disorders. The symptoms associated with PHPT are neither typical nor specific. Asymptomatic PHPT is often diagnosed accidentally, based on laboratory results. The article presents case of 31-year old woman with chronic kidney disease (CKD) stage 4, persistent hypercalcemia, hypophosfataemia. Tertiary hyperparathyroidism (THPT) is most often situation when these disturbances occur but in this clinical situation CKD and PHPT is more likely. Paraendocrynopathy is also taken into consideration. Diagnostic methods estimate serum concentration of calcium and phosphate on each stage of CKD allowed to exclude THPT. Cinacalcet treatment followed by parathyroid surgery reduced serum calcium concentration.