From the Guidelines
High parathyroid hormone (PTH) levels are primarily associated with primary hyperparathyroidism, secondary hyperparathyroidism, and tertiary hyperparathyroidism, with the most recent evidence suggesting a strong link between elevated PTH and chronic kidney disease, vitamin D deficiency, and malabsorption syndromes 1.
Conditions Associated with Elevated PTH
The following conditions are associated with high PTH levels:
- Primary hyperparathyroidism: typically results from a benign parathyroid adenoma causing autonomous PTH secretion, leading to hypercalcemia
- Secondary hyperparathyroidism: occurs when the body increases PTH production to compensate for low calcium levels, commonly seen in chronic kidney disease, vitamin D deficiency, and malabsorption syndromes
- Tertiary hyperparathyroidism: develops when longstanding secondary hyperparathyroidism becomes autonomous and no longer responds to calcium levels
- Other conditions: pseudohypoparathyroidism, certain medications (like lithium and thiazide diuretics), familial hypocalciuric hypercalcemia, and some malignancies that produce PTH-related protein
Clinical Implications
Elevated PTH can lead to:
- Bone demineralization
- Kidney stones
- Psychiatric symptoms
- Cardiovascular complications
Treatment
Treatment depends on the underlying cause and may include:
- Parathyroidectomy for primary hyperparathyroidism
- Vitamin D supplementation
- Phosphate binders
- Calcimimetics like cinacalcet
- Addressing the underlying kidney disease in secondary hyperparathyroidism, with recent studies suggesting that novel calcimimetics (etelcalcetide, evocalcet, and upacicalcet) have similar or superior efficacy to cinacalcet for PTH reduction 1
From the FDA Drug Label
1.1 Secondary Hyperparathyroidism 1.2 Parathyroid Carcinoma 1.3 Primary Hyperparathyroidism
The diseases associated with high parathyroid hormone (PTH) levels are:
- Secondary Hyperparathyroidism
- Parathyroid Carcinoma
- Primary Hyperparathyroidism 2
From the Research
Diseases Associated with High Parathyroid Hormone (PTH) Levels
High parathyroid hormone (PTH) levels are associated with several diseases, including:
- Primary hyperparathyroidism, which is the most common cause of hypercalcemia 3
- Secondary hyperparathyroidism, which commonly develops in patients with chronic kidney disease (CKD) in response to high phosphate, low calcium, and low 1,25-dihydroxyvitamin D(3) levels 4, 5, 6, 7
- Tertiary hyperparathyroidism, which is characterized by excessive secretion of PTH after longstanding secondary hyperparathyroidism, often occurring in patients with chronic kidney disease after kidney transplant 5, 7
- Renal osteodystrophy, which is a complication of secondary hyperparathyroidism in patients with CKD 5
- Vascular calcification, which can occur as a result of high PTH levels and is associated with increased risk of cardiovascular disease 4, 5, 6
- Adynamic bone disease, which can occur as a result of oversuppression of PTH levels, leading to an increased risk of vascular calcification 4, 6
Management of High PTH Levels
Management of high PTH levels depends on the underlying cause and may include:
- Surgical treatment, such as parathyroidectomy, for primary hyperparathyroidism 3
- Medical treatment, such as vitamin D analogs and calcimimetics, for secondary and tertiary hyperparathyroidism 4, 5, 6
- Reduction of high phosphate levels and correction of vitamin D deficiency for secondary hyperparathyroidism 3