Secondary Hyperparathyroidism

  • Hyperparathyroidism is an inevitable feature of end-stage renal disease (ESRD):
    • It is a result of decreased renal tubular excretion of phosphate and defective 1-α hydroxylase enzyme:
      • Which cause impaired renal activation of 25-hydroxycholecalciferal to 1,25 dihydroxycholecalciferol
        • These causes hyperphosphatemia and hypovitaminosis D:
          • Which result in prolonged hypocalcemia:
            • That lead to hyperplasia of the chief cells of the parathyroid glands:
              • And eventually increased secretion of parathyroid hormone (PTH)
  • When the condition is chronic and prolonged:
    • The pathologic changes may become irreversible:
      • With skeletal resistance to PTH
      • Autonomous function of the hyperplastic glands:
        • Even with correction of the underlying cause and withdrawal of calcium and calcitriol therapy
  • Parathyroidectomy:
    • Is usually warranted in severe refractor renal hyperparathyroidism:
      • After failure of pharmacologic treatment with calcitriol, a vitamin D analog, or cinacalcet
    • The procedure is also considered when the medical therapy to reduce the level of intact PTH (iPTH):
      • Results in unacceptable elevation of the serum calcium and / or phosphorus:
        • With the potential for precipitation and increased cardiovascular mortality:
          • When the calcium-phosphate product exceeds 55 mg2/dl2) or when the adverse effects of the pharmacotherapy are not tolerated by the patient

#Arrangoiz #ParathyroidSurgeon #ParathyroidExpert #Hyperparathyroidism #Surgeon #HeadandNeckSurgeon #Teacher #MSMC #MountSinaiMedicalCenter #Miami #Mexico #EndocrineSurgery

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