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Secondary and Tertiary Hyperparathyroidism: A Narrative Review
W Y van der Plas1, M E Noltes1, T M van Ginhoven2
1Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Summary
Secondary and tertiary hyperparathyroidism in end-stage renal disease patients increases mortality risk. This review covers pathogenesis, diagnosis, and treatment options like vitamin D, binders, calcimimetics, and surgery.
Area of Science:
- Nephrology
- Endocrinology
- Internal Medicine
Background:
- End-stage renal disease (ESRD) frequently leads to secondary and tertiary hyperparathyroidism.
- This condition involves elevated parathormone, calcium, and phosphate levels.
- Associated symptoms include pruritus, osteodynia, cognitive issues, and depression, with long-term risks of mortality.
Purpose of the Study:
- To review the pathogenesis of hyperparathyroidism in ESRD patients.
- To outline the clinical presentation and diagnostic work-up.
- To discuss current treatment options and their indications.
Main Methods:
- Literature review of pathogenesis, clinical presentation, diagnostics, and treatments for hyperparathyroidism in ESRD.
- Synthesis of information on vitamin D supplements, phosphate binders, calcimimetics, and parathyroidectomy.
Main Results:
- Hyperparathyroidism in ESRD presents with specific biochemical and clinical features.
- Multiple treatment modalities exist, each with specific indications.
- Optimal individualized treatment selection remains a clinical challenge.
Conclusions:
- Understanding hyperparathyroidism's pathogenesis and presentation is crucial for ESRD management.
- A range of treatments are available, requiring careful consideration for each patient.
- Further research may aid in optimizing treatment strategies for improved patient outcomes.
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