Parathyroid

Hyperparathyroidism is related to an overactivity of the parathyroid glands resulting in excess production of parathyroid hormone (PTH). In primary hyperparathyroidism (HPT1), an autonomous overproduction of PTH is observed, due to the ability of parathyroid cells to proliferate into large hyper-functioning glands. Secondary hyperparathyroidism (HPT2) refers to the excessive secretion of PTH by the parathyroid glands in response to hypocalcemia from any cause. It is mainly observed in patients with Chronic Kidney Disease [CKD]. HPT2 progresses as renal function deteriorates and most people with End-Stage Renal Disease [ESRD] (CKD stage 5) will have HPT2 to varying degrees.

The consequences of untreated HPT1 can range in severity from no demonstrable health effects to major lifethreatening problems. The most likely risks are progressive silent bone loss that increases the future risk of occurrence of fractures and nephrolithiasis or nephrocalcinosis with impairment of renal function.

In CKD patients, long-lasting hypocalcemia and coincidental hyperphosphatemia lead to the stimulation of parathyroid glands and subsequent HPT2, which causes decalcification of bones. Moreover, hyperphosphatemia has been recognized as an important risk factor for cardiovascular disease [CVD] mortality in patients with CKD. These complications markedly and negatively affect the prognosis and quality of life of patients with CKD.