 | This article needs more reliable medical references for verification or relies too heavily on primary sources. (March 2019) |  |
| Tertiary Hyperparathyroidism | |
|---|---|
 | |
| Thyroid and parathyroid | |
| Specialty | Endocrinology |
| Symptoms | None, kidney stones, weakness, depression, bone pains, confusion, increased urination |
| Complications | Osteoporosis |
| Usual onset | 50 to 60 |
| Types | Primary, secondary, tertiary |
| Causes | Tertiary: parathyroid adenoma, multiple benign tumors, parathyroid cancer, parathyroid hyperplasia, growth of parathyroid tissue, secondary hyperparathyroidism |
| Diagnostic method | High blood calcium and high PTH levels |
| Treatment | Surgery, intravenous normal saline |
| Frequency | ~2 per 1,000 |
Tertiary hyperparathyroidism is a condition involving the overproduction of the hormone, parathyroid hormone, produced by the parathyroid glands.[1] The parathyroid glands are involved in monitoring and regulating blood calcium levels and respond by either producing or ceasing to produce parathyroid hormone.
Anatomically, these glands are located in the neck, para-lateral to the thyroid gland, which does not have any influence in the production of parathyroid hormone. Parathyroid hormone is released by the parathyroid glands in response to low blood calcium circulation. Persistent low levels of circulating calcium are thought to be the catalyst in the progressive development of adenoma, in the parathyroid glands resulting in primary hyperparathyroidism. While primary hyperparathyroidism is the most common form of this condition,[2][3][4] secondary and tertiary are thought to result due to chronic kidney disease (CKD).[2] Estimates of CKD prevalence in the global community range from 11 to 13% which translate to a large portion of the global population at risk of developing tertiary hyperparathyroidism.[5]
Tertiary hyperparathyroidism was first described in the late 1960s and had been misdiagnosed as primary prior to this.[6] Unlike primary hyperparathyroidism, the tertiary form presents as a progressive stage of resolved secondary hyperparathyroidism with biochemical hallmarks that include elevated calcium ion levels in the blood, hypercalcemia, along with autonomous production of parathyroid hormone and adenoma in all four parathyroid glands.[1] Upon diagnosis treatment of tertiary hyperparathyroidism usually leads to a surgical intervention.[7]
- ^ a b Pitt SC, Sippel RS, Chen H (October 2009). "Secondary and tertiary hyperparathyroidism, state of the art surgical management". The Surgical Clinics of North America. 89 (5): 1227–39. doi:10.1016/j.suc.2009.06.011. PMC 2905047. PMID 19836494.
- ^ a b Callender GG, Carling T, Christison-Lagay E, Udelsman R (2016). "Chapter 65 - Surgical Management of Hyperparathyroidism". In Jameson JL, De Groot LJ, de Kretser DM, Giudice LC (eds.). Endocrinology: Adult and Pediatric (Seventh ed.). W.B. Saunders. pp. 1135–1146.e3. doi:10.1016/b978-0-323-18907-1.00065-2. ISBN 978-0-323-18907-1.
- ^ Clayman GL, Gonzalez HE, El-Naggar A, Vassilopoulou-Sellin R (March 2004). "Parathyroid carcinoma: evaluation and interdisciplinary management". Cancer. 100 (5) (Seventh ed.). W.B. Saunders: 900–5. doi:10.1016/b978-0-323-18907-1.00065-2. ISBN 978-0-323-18907-1. PMID 14983483.
- ^ van der Plas WY, Noltes ME, van Ginhoven TM, Kruijff S (July 2019). "Secondary and Tertiary Hyperparathyroidism: A Narrative Review". Scandinavian Journal of Surgery. 109 (4): 271–278. doi:10.1177/1457496919866015. PMID 31364494.
- ^ Hill NR, Fatoba ST, Oke JL, Hirst JA, O'Callaghan CA, Lasserson DS, Hobbs FD (2016-07-06). Remuzzi G (ed.). "Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis". PLOS ONE. 11 (7): e0158765. Bibcode:2016PLoSO..1158765H. doi:10.1371/journal.pone.0158765. PMC 4934905. PMID 27383068.
- ^ Davies DR, Dent CE, Watson L (August 1968). "Tertiary hyperparathyroidism". British Medical Journal. 3 (5615): 395–9. doi:10.1136/bmj.3.5615.395. PMC 1986316. PMID 5691200.
- ^ Gasparri G, Camandona M, Abbona GC, Papotti M, Jeantet A, Radice E, et al. (January 2001). "Secondary and tertiary hyperparathyroidism: causes of recurrent disease after 446 parathyroidectomies". Annals of Surgery. 233 (1): 65–9. doi:10.1097/00000658-200101000-00011. PMC 1421168. PMID 11141227.