Hyperparathyroidism natural history, complications and prognosis

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Hyperparathyroidism Microchapters


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]


Primary hyperparathyroidism usually develops in the fifth decade of life, in post-menopausal women and starts as asymptomatic hypercalcemia in presence of increased parathyroid hormone. If left untreated, some of patients with primary hyperparathyroidism may commonly develop marked hypercalcemia, marked hypercalciuria, cortical bone demineralization and nephrolithiasis.

Secondary hyperparathyroidism arise in the early course of chronic renal failure. As renal failure progress, secondary hyperparathyroidism becomes more notable. If left untreated, secondary hyperparathyroidism carries an increased risk of vascular calcification with increasing age and duration of dialysis in patients.

Tertiary hyperparathyroidism usually develops in post renal transplant patients. If left untreated, tertiary hyperparathyroidism in post renal transplant patients may carry the risk of amyloid deposition, calciphylaxis, destructive or erosive spondyloarthropathy, osteonecrosis, and musculoskeletal infections.

Hyperparathyroidism leads to a variety of complications in various organ systems depending on the type of hyperparathyroidism.

Prognosis is all types hyperparathyroidism is generally good after proper treatment.

Natural History

Primary hyperparathyroidism

Secondary hyperparathyroidism

Tertiary hyperparathyroidism


Complications involving Organ system Complications of hyperparathyroidism
Primary hyperparathyroidism Secondary hyperparathyroidism Tertiary hyperparathyroidism
Cardiaovascular complications


Endocrine complications[8] -- --
Gastrointestinal complications[9] -- --
Hematologic complications[10] ---
  • Platlet function inhibition
Metabolic complications


Musculo-skeletal complications


Neurologic complications


--- --
Neuromuscular complications


Pregnancy related complications[26] -- --
Psychiatric complications


-- --
Renal complications


Rheumatologic complications


System non-specific complications


  • Metastatic calcifications
  • Amyloid deposition
  • Metastatic calcifications


Primary hyperparathyroidism

  • Prognosis of primary hyperparathyroidism is generally excellent after parathyroidectomy.
  • The complications of primary hyperparathyroidism resolves after the treatment.
  • Untreated complication of primary hyperparathyroidism may be fatal.[9]

Secondary hyperparathyroidism

Tertiary hyperparathyroidism

  • Prognosis of tertiary hyperparathyroidism is generally good after resection of abnormal hyperplastic gland.[38]


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