25 What is the treatment of secondary hyperparathyroidism? • Correction of the underlying cause, such as renal transplant in patients with renal failure or vitamin D therapy in vitamin D deficiency • Patient symptoms from secondary disease may improve with medications such as cincalcet or bisphosophate therapy. • There is a role for subtotal parathyroidectomy if medical management fails. 26 What is tertiary hyperparathyroidism? Tertiary hyperparathyroidism is a state of excess secretion of PTH after long-standing secondary hyperparathyroidism. Phosphate levels in tertiary hyperparathyroidism are decreased; however, renal dysfunction may lead to hyperphosphatemia despite elevated PTH levels. A classic example is hyperparathyroidism persisting after renal transplantation. 27 What is the pathophysiology of tertiary hyperparathyroidism? The hypertrophied parathyroid glands become autonomous in their function and hypersecrete PTH, leading to hypercalcemia despite withdrawal of calcium and calcitriol.
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