Hyperparathyroidism classification
Different causes and features of hyperparathyroidism - raised parathormone (PTH).
| primary | secondary | tertiary | |
|---|---|---|---|
| pathology | Hyperfunction of parathyroid cells due to hyperplasia, adenoma or carcinoma. | Physiological stimulation of parathyroid in response to hypocalcaemia. | Following long term physiological stimulation leading to hyperplasia. |
| associations | May be associated with multiple endocrine neoplasia. | Usually due to chronic renal failure or other causes of Vitamin D deficiency. | Seen in chronic renal failure. |
| serum calcium | high | low / normal | high |
| serum phosphate | low / normal | high | high |
| management | Usually surgery if symptomatic. Cincacalcet can be considered in those not fit for surgery. | Treatment of underlying cause. | Usually cinacalcet or surgery in those that don't respond. |
NICE have issued guidance for the use of cinacalcet in what they call refractory secondary hyperparathyroidism which is classified as tertiary hyperparathyroidism in this tblable. http://www.nice.org.uk/TA117
