Tertiary hyperparathyroidism is a state of excessive secretion of parathyroid hormone (PTH) after a long period of secondary hyperparathyroidism and resulting in hypercalcemia. It reflects development of autonomous (unregulated) parathyroid function following a period of persistent parathyroid stimulation.
The basis of treatment is still prevention in chronic renal failure, starting medication and dietary restrictions long before dialysis treatment is initiated. Cinacalcet has greatly reduced the number of patients who ultimately require surgery for secondary hyperparathyroidism; however, approximately 5% of patients do not respond to medical therapy.
When secondary hyperparathyroidism is corrected and the parathyroid glands remain hyperfunctioning, it becomes tertiary hyperparathyroidism. The treatment of choice is surgical removal of three and one half parathyroid glands.
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“Morality is a venereal disease. Its primary stage is called virtue; its secondary stage, boredom; its tertiary stage, syphilis.”
—Karl Kraus (1874–1936)