Secondary and Tertiary hyperparathyroidism

In addition to primary hyperparathyroidism, there are situations where calcium levels are elevated because of secondary hyperparathyroidism or tertiary hyperparathyroidism. Parathyroid diagnosis and treatment implies a full history prior to assessing the causes of hypercalcemia. Parathyroid disease diagnosis has been simplified recently with the ability to measure intact parathyroid hormone levels. Parathyroid disease treatment has therefore been simplified as well. Parathyroid disorders are more common than is recognized and are often misdiagnosed or overlooked. Parathyroid gland diseases occur in both patients who are otherwise healthy or may have other problems. The parathyroid hormone test that is currently used measures the intact hormone and therefore is extremely precise. In the past, parathyroid hormone osteoporosis was diagnosed with a much more complicated system of testing. In fact, parathyroid symptoms can be easily diagnosed if calcium levels are shown to be elevated. The problem with the diagnosis of parathyroid symptoms is that the symptoms are so vague that when the patient visits a parathyroid treatment center, the correct diagnosis may not be made.

Secondary hyperparathyroidism and tertiary hyperparathyroidism are associated with chronic renal disease. Patients with chronic renal disease have high serum calcium. In a patient with chronic renal disease, there may be low serum calcium levels, normal calcium levels, or elevated calcium levels. In the early phases of renal disease, calcium is lost and therefore calcium levels are low. The serum calcium value would be lower than normal. The body tries to recover and improve calcium levels and therefore the body produces more parathyroid hormone level in response to the low calcium levels. Serum calcium levels can cause an increase in parathyroid hormone production. Hence, the term 'secondary hyperparathyroidism' is a result of low calcium levels. The patients with secondary hyperparathyroidism therefore have high parathyroid hormone levels but have low calcium levels. Over a period of many years, this persistent stimulation of the parathyroid gland results in an autonomous gland that is not responsive to the control mechanism. The patient therefore may have return of calcium levels but even with the return-to-normal calcium levels the enlarged glands will now continue to produce parathyroid hormone levels that are too high. The symptoms of hyperparathyroidism in patients with tertiary hyperparathyroidism are quite similar however to primary hyperparathyroidism. The symptoms of high calcium are not as significant because in many of these patients the calcium level is not high but their parathyroid hormone levels are high. The most frequent symptom associated with tertiary hyperparathyroidism is bone pain. Many of the patients with renal disease have thyroid and parathyroid disease and require treatment for parathyroid disease. Uncontrolled bone pain and uncontrolled tertiary hyperparathyroidism requires surgery by a parathyroid surgeon.

The treatment for tertiary hyperparathyroidism is quite different than primary hyperparathyroidism. In patients with tertiary hyperparathyroidism, the glands are extremely large, sometimes being more than a 100 times normal size. In these cases, all four glands are removed from the neck. Because the patient does require parathyroid tissue, the glands are microdissected and then autotransplanted into the muscle of the forearm of the patient. This autotransplantation allows for better control of hyperplastic tissue that may occur in the future. If the hyperplastic parathyroid tissue is placed into the muscle of the forearm, it is easily removed with a small incision on the forearm with a local anesthetic. The need for additional surgery is then eliminated. In certain cases of tertiary hyperparathyroidism some of the tissue is cryopreserved in order that it may be used at some future time if parathyroid hormone levels become too low. In these patients, when there is too much calcium in the blood or too much calcium is detected by other tests, some of the parathyroid tissue can be removed from the forearm with a simple procedure. Too much calcium in the body even in patients with tertiary hyperparathyroidism can cause significant effects.