Tertiary Hyperparathyroidism Diagnosis and Treatment

Definition and Characteristics

• Tertiary hyperparathyroidism is characterized by a lack of PTH suppression despite rising serum calcium levels, manifesting as hypercalcemic hyperparathyroidism that occurs in patients with long-standing secondary hyperparathyroidism 1
• It is most commonly encountered following kidney transplantation in patients with long-standing chronic kidney disease 1

Treatment

• Surgical excision (parathyroidectomy) is recommended for medically refractory cases 1
• As tertiary hyperparathyroidism typically involves multigland disease (parathyroid hyperplasia), preoperative imaging aims to identify all eutopic and potential ectopic or supernumerary glands to guide the surgical approach 1