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Tertiary Hyperparathyroidism in Diabetic Nephropathy: An Underrecognized Complication-A Narrative Review
Mirona Costea1,2, Dana-Mihaela Tilici1,2, Diana Loreta Paun2,3
1Doctoral School, University of Medicine and Pharmacy "Carol Davila", 020021 Bucharest, Romania.
Biomedicines
|November 27, 2025
Summary
Tertiary hyperparathyroidism (THPT) in chronic kidney disease (CKD) patients involves autonomous parathyroid hormone secretion, persisting even after kidney transplants. This condition causes hypercalcemia, bone loss, and cardiovascular risks, with management strategies still under investigation.
Area of Science:
- Nephrology
- Endocrinology
- Surgical Pathology
Background:
- Tertiary hyperparathyroidism (THPT) develops from prolonged secondary hyperparathyroidism in chronic kidney disease (CKD).
- Persistent parathyroid hyperplasia post-renal transplant leads to elevated parathyroid hormone (PTH) and hypercalcemia.
- These metabolic disturbances increase risks of bone loss, vascular calcification, and cardiovascular events.
Purpose of the Study:
- To review the pathophysiology, clinical features, and management of THPT.
- To highlight areas needing further research and consensus in THPT treatment.
Main Methods:
- Literature review of THPT pathophysiology, clinical manifestations, and management strategies.
- Analysis of current medical (calcimimetics, vitamin D analogues) and surgical (parathyroidectomy) treatment options.
Main Results:
- THPT is characterized by autonomous PTH secretion and hypercalcemia, often persisting post-transplant.
- Associated complications include bone disease and cardiovascular complications.
- Current management involves medical and surgical options, but optimal strategies are not well-defined.
Conclusions:
- Optimal timing and treatment strategies for THPT require further investigation.
- Addressing THPT is crucial for mitigating its associated complications in CKD patients.
- Further research is needed to establish clear guidelines for THPT management.
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