From the Guidelines
Elevated Parathyroid Hormone (PTH) levels are primarily caused by secondary hyperparathyroidism, which is a common complication of chronic kidney disease (CKD) due to the malregulation of calcium and phosphate, leading to compensatory hyperplasia of the parathyroid gland and increased secretion of PTH 1.
Causes of Elevated PTH Levels
The causes of elevated PTH levels can be categorized into primary, secondary, and tertiary hyperparathyroidism.
- Primary hyperparathyroidism is most commonly caused by a benign parathyroid adenoma, but can also result from parathyroid hyperplasia or, rarely, parathyroid carcinoma.
- Secondary hyperparathyroidism develops as a compensatory response to chronic hypocalcemia, with the most common causes being vitamin D deficiency, chronic kidney disease, and malabsorption syndromes, as seen in patients with CKD who suffer from severe endocrine disturbance, resulting in unacceptable rates of mortality and cardiovascular morbidity 1.
- Tertiary hyperparathyroidism occurs when longstanding secondary hyperparathyroidism leads to autonomous PTH secretion.
Diagnosis and Treatment
Diagnosis typically involves measuring serum calcium, phosphate, vitamin D, and kidney function alongside PTH levels to determine the underlying cause.
- Treatment depends on addressing the specific cause, ranging from parathyroidectomy for primary hyperparathyroidism to vitamin D supplementation, phosphate binders, or calcimimetics for secondary causes.
- In patients with CKD, surgical treatment of secondary hyperparathyroidism, such as total parathyroidectomy (TPTX) or total parathyroidectomy with autotransplantation (TPTX + AT), may be necessary to quickly relieve the electrolyte disorder and reduce the incidence of various complications of CKD, such as stroke and cardiovascular and all-cause mortality 1.
From the FDA Drug Label
Cinacalcet tablet is a positive modulator of the calcium sensing receptor indicated for: • Secondary Hyperparathyroidism (HPT) in adult patients with chronic kidney disease (CKD) on dialysis. • Hypercalcemia in adult patients with Parathyroid Carcinoma (PC). • Hypercalcemia in adult patients with primary HPT for whom parathyroidectomy would be indicated on the basis of serum calcium levels, but who are unable to undergo parathyroidectomy.
The causes of elevated Parathyroid Hormone (PTH) levels are:
- Secondary Hyperparathyroidism (HPT) in adult patients with chronic kidney disease (CKD) on dialysis
- Parathyroid Carcinoma (PC)
- Primary HPT 2
From the Research
Causes of Elevated Parathyroid Hormone (PTH) Levels
The causes of elevated PTH levels can be categorized into several types of hyperparathyroidism, including:
- Primary hyperparathyroidism: caused by a single parathyroid adenoma, multiglandular disease, or cancer 3, 4, 5, 6, 7
- Secondary hyperparathyroidism: caused by chronic kidney disease-mineral and bone disorder (CKD-MBD), severe calcium or vitamin D deficiency, or other conditions that affect calcium homeostasis 3, 4, 5, 6, 7
- Tertiary hyperparathyroidism: caused by autonomous PTH secretion by the parathyroid glands after prolonged stimulation under secondary hyperparathyroidism 5, 6
Specific Causes of Elevated PTH Levels
Some specific causes of elevated PTH levels include:
- Parathyroid adenoma 3, 4, 5, 6, 7
- Chronic kidney disease (CKD) 3, 4, 5, 6, 7
- Vitamin D deficiency 3, 4, 5, 6, 7
- Severe calcium deficiency 3, 5
- Gastrointestinal conditions that impair calcium absorption 7
- Certain drugs 5
- Familial hypocalciuric hypercalcemia (FHH) 5
- Multiple endocrine neoplasia types 1 and 2A 7
- Parathyroid cancer 7