What Is Secondary Hyperparathyroidism?

Secondary hyperparathyroidism is a serious medical condition defined by compromised parathyroid function. Individuals with hyperparathyroidism are considered at risk for complications associated with long-term calcium deprivation, such as osteoporosis. Treatment can range from close monitoring to surgery depending on symptom severity.

The parathyroid glands are responsible for maintaining proper calcium levels in the blood with the secretion of parathyroid hormone (PTH). Similar to how insulin is released to regulate glucose levels, an imbalance of calcium can trigger the secretion of PTH into the blood. Whether calcium levels rise or fall, the parathyroid glands work to maintain balance.

Individuals with secondary hyperparathyroidism have an existing illness that continuously depletes calcium from their system, such as chronic renal failure. Unable to keep up, despite working overtime, the parathyroid glands cannot adequately offset the loss. Impaired kidney function often contributes to vitamin D depletion that keeps the body drained of calcium. Secondary hyperparathyroidism may also result from impaired calcium absorption due to malnutrition.

Blood tests are the first diagnostic tool used to confirm a diagnosis. Markers indicative of inadequate calcium and elevated PTH levels can lead to more tests. Urinalysis and imaging tests, including ultrasound, are usually ordered to assess kidney function and identify whether the parathyroid glands have been directly affected and, if so, to what extent. A bone density test may also be performed to evaluate calcium levels and detect significant changes to bone structure and composition, including fractures and softening.

Calcium depletion resulting from secondary hyperparathyroid can trigger several signs and symptoms. Subtle signs associated with parathyroid gland dysfunction can include impaired cognition, widespread joint discomfort and swelling, and a decrease in appetite. It is not uncommon for some individuals to experience flu-like symptoms, including nausea and pronounced fatigue. Long-term calcium deprivation can contribute to bone fragility and increase one’s risk for bone discomfort and fracture.

Mild cases of secondary hyperparathyroidism may only require regular monitoring of PTH and calcium levels while the underlying condition is treated. Supplemental vitamin D is often prescribed to treat deficiency and alleviate some symptoms. Synthetic calcium therapy may also be used to treat the effects of secondary hyperparathyroidism.

When parathyroid function is significantly impaired, surgery may be performed to remove the affected gland. As with any invasive procedure, surgery does carry some risk for complication, including infection and nerve damage. Following surgery, hormone replacement therapy may be necessary to offset the effects of the partial or complete parathyroid removal. Individuals with secondary hyperparathyroidism triggered by chronic renal failure may undergo dialysis or kidney transplantation.