Primary: Elevated PTH that results in elevated Ca2+. Typically caused by parathyroid adenoma.
Secondary: Elevated PTH due to Low Ca2+ (Hypocalcemia). Seen commonly in chronic kidney disease causing low Vitamin D synthesis and hyperphosphatemia. Also seen in several malabsorptive states (i.e chronic pancreatitis).
Tertiary: Elevated PTH due to hyperplasia/ hypersecretion from the paraythroid gland in the setting of long-standing secondary hyperparathyroidism (i.e CKD). This results in elevated PTH AND elevated Ca2+, even after correction of the secondary cause.
REFERENCES
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