Categories: Endocrinology

Hyperparathyroidism: Primary, Secondary, Tertiary

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. 


  1. Pitt SC, Sippel RS, Chen H. Secondary and Tertiary Hyperparathyroidism, State of the Art Surgical Management. The Surgical clinics of North America. 2009;89(5):1227-1239. doi:10.1016/j.suc.2009.06.011.
  2. Ahmad R., Hammond JM. Primary, secondary, and tertiary hyperparathyroidism. Otolaryngol Clin North Am. 2004 Aug;37(4):701-13, vii-viii.
  3. Russell RI. Hypoparathyroidism and malabsorption. British Medical Journal. 1967;3(5568):781-782.
Get Medical Pearls directly to your inbox every week!
Weekly posts with high yield medical knowledge, directly to your mailbox!
Dr. C Humphreys

Internal Medicine

Recent Posts

Why is Pro-BNP/ BNP lower in Obesity?

B-type natriuretic peptide (BNP) is a hormone created in response to cardiac wall stretch due…

3 months ago

What is Peribronchovascular Distribution on CT imaging?

A common finding described on computed tomography (CT) imaging. A disease with a peribronchovascular distribution…

10 months ago

Trapped Lung vs. Lung Entrapment

Though often used synonymously; Trapped Lung and Lung Entrapment technically describe separate entities along the…

1 year ago

Cause of Pericardial Effusion in Pulmonary Hypertension: Pathogenesis

It is not clearly understood why patients with pulmonary hypertension (PH) develop pericardial effusions. However,…

1 year ago

Difference between Mycophenolate Mofetil vs. Mycophenolate Sodium

The two drugs are not interchangeable nor dose equivalents. Mycophenolate mofetil (Cellcept) is a semi…

2 years ago

What is an “Anephric” Creatinine Rise?

Serum Creatinine can be a deceptive surrogate during an acute kidney injury. It may lag…

2 years ago

This website uses cookies.