A study of tertiary hyperparathyroidism

Information on tertiary hyperparathyroidism (THPTH) among chronic kidney disease (CKD) patients on haemodialysis in developing countries such as India is limited, and the mortality among them remains a query.

This was a prospective cohort study conducted in at a tertiary care centre from June 2017 to June 2022. The index of suspicion for tertiary hyperparathyroidism was when investigations revealed high serum calcium and high alkaline phosphatase along with new onset of body aches, joint pains, and difficulty in walking. Patients, with above clinical features, were considered for 99 m Tc-Sestamibi scan and high-resolution ultrasound of the neck, when serum parathormone was > 600 pg/mL. Those patients diagnosed with tertiary hyperparathyroidism were followed up for 5 years.

The incidence of tertiary hyperparathyroidism among CKD patients was 13.4%. The mean age of CKD stage 5 patients with tertiary hyperparathyroidism was 55.17 ± 11.1 years. The observation from our study was the mean survival time among patients who underwent parathyroidectomy and among patients who received cinacalcet was almost similar, whereas the mean survival time among patients who received phosphate binders was lower. However, the survival rate among patients on cinacalcet and who underwent parathyroidectomy were not statistically significant.

There were no cross-sectional studies on prevalence of tertiary hyperparathyroidism in India as per our knowledge, although the prospective design, large sample size, PTH stratification, and frequent measurements of a comprehensive panel of mineral metabolites are strengths of the current study.