Skip to Main Content


  • • Autonomous, hyperplastic parathyroid glands in a patients with secondary hyperparathyroidism

    • Persistent hypercalcemia following normalization of renal function (usually with renal transplantation)


Laboratory Findings


  • • Elevated intact parathyroid hormone levels

    • Elevated serum calcium and phosphate levels

    • Elevated alkaline phosphatase levels


  • • Consider malignancy in appropriate clinical settings


  • • Measure serum calcium and intact parathyroid hormone




  • • Surgical therapy is withheld until all medical approaches have been exhausted




  • • Hyperparathyroidism refractory to all medical therapies

    • Calcium-phosphate product greater than 70

    • Severe bone pain

    • Pruritus

    • Extensive soft-tissue calcification with tumoral calcinosis

    • Calciphylaxis




  • • Phosphate binders

    • Calcium supplementation

    • Vitamin D


Treatment Monitoring


  • • Serum calcium level




  • • Usually dramatic relief of symptoms once treated (medically or surgically)

    • Few patients continue to have bone pain due to osteomalacia

    • Few patients can have profound hypoparathyroidism because of remineralization of bones ("hungry bones") and because of decreased parathyroid hormone secretion



Pasieka JL, Parsons LL: A prospective surgical outcome study assessing the impact of parathyroidectomy on symptoms in patients with secondary and tertiary hyperparathyroidism. Surgery 2000;128:531.  [PubMed: 11015085]
Savio RM et al: Parathyroidectomy for tertiary hyperparathyroidism associated with X-linked dominant hypophosphatemic rickets. Arch Surg 2004;139:218.  [PubMed: 14769584]
Schlosser K, Zielke A, Rothmund M: Medical and surgical treatment for secondary and tertiary hyperparathyroidism. Scand J Surg 2004;93:288.  [PubMed: 15658670]
Triponez F et al: Less-than-subtotal parathyroidectomy increases the risk of persistent/recurrent hyperparathyroidism after parathyroidectomy in tertiary hyperparathyroidism after renal transplantation. Surgery 2006;140:990.  [PubMed: 17188148]

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.