End-stage renal disease is often complicated by the occurrence of secondary and eventually tertiary hyperparathyroidism, characterized by increased parathormone, calcium, and phosphate concentrations. Related symptoms include pruritus and osteodynia, concentration difficulties, and feelings of depression may be present. In the long-term, end-stage renal disease patients with hyperparathyroidism have an increased risk of all-cause and cardiovascular mortality. Among treatment options are vitamin D supplements, phosphate binders, calcimimetics, and surgical parathyroidectomy. Determining the optimal treatment for the individual patient is challenging for nephrologists and endocrine surgeons. This review resumes the pathogenesis of hyperparathyroidism, clinical presentation, required diagnostic work-up, and discusses indications for the available treatment options for patients with secondary and tertiary hyperparathyroidism.

Additional Metadata
Keywords calcimimetics, end-stage renal disease, parathyroidectomy, Secondary hyperparathyroidism
Persistent URL dx.doi.org/10.1177/1457496919866015, hdl.handle.net/1765/118679
Journal Scandinavian Journal of Surgery
Citation
van der Plas, W.Y. (W. Y.), Noltes, M.E. (M. E.), van Ginhoven, T.M, & Kruijff, S. (2019). Secondary and Tertiary Hyperparathyroidism: A Narrative Review. Scandinavian Journal of Surgery. doi:10.1177/1457496919866015