What is Secondary Hyperparathyroidism?
Secondary hyperparathyroidism is a compensatory hyperfunction and hyperplasia of the parathyroid gland that develops with prolonged hypocalcemia and hyperphosphatemia of various origins.
Causes of Secondary Hyperparathyroidism
- Renal pathology: chronic renal failure, tubulopathy, renal rickets.
- Intestinal pathology: malabsorption syndrome.
- Bone pathology: osteomalacia, Paget’s disease.
- Vitamin D deficiency: kidney disease, liver disease, hereditary fermentopathy.
- Malignant diseases: myeloma.
The main causes of secondary hyperparathyroidism are kidney failure and digestive system diseases.
Symptoms of Secondary Hyperparathyroidism
The symptoms of the underlying disease dominate, most often chronic renal failure. Specific symptoms are bone pain, weakness in the proximal parts of the mouse, arthralgia. Spontaneous fractures and skeletal deformities may occur. The formation of extraosseous calcifications has various clinical manifestations. With arterial calcification, ischemic changes may develop. On the arms and legs, periarticular calcifications can be detected. Calcification of the conjunctiva and cornea in combination with recurrent conjunctivitis is referred to as red eye syndrome.
Diagnosis of Hyperparathyroidism Secondary
- Normocalcemia combined with elevated levels of parathyroid hormone. In addition, hyperphosphatemia, a high level of alkaline phosphatase, and a low level of 1.25- (OH) 2-O3 are characteristic. Determining the level of parathyroid hormone is recommended for nephropathy of any genesis with a decrease in glomerular filtration rate of less than 60%.
- Bone changes are similar to primary hyperparathyroidism (osteoporosis, subperiosteal and subchondral resorption of the bones of the hand, etc.).
- Diagnosis of the underlying disease (chronic renal failure, malabsorption).
Treatment of Hyperparathyroidism Secondary
In chronic renal failure, the prevention of osteopathy is indicated with an increase in the level of inorganic phosphorus in the plasma of more than 1.5 mmol / L. For this purpose, active metabolites of vitamin D are prescribed, with a tendency to hypocalcemia – in combination with calcium preparations. With a three-fold increase in the level of parathyroid hormone and / or an increase in the level of blood calcium more than 2.6-2.7 mmol / l, subtotal parathyroidectomy is indicated.