PAEA Surgery End Of Rotation (EOR) Practice Exam

What type of hyperparathyroidism occurs persistently after the correction of secondary hyperparathyroidism?

1. Primary hyperparathyroidism

2. Tertiary hyperparathyroidism

3. Secondary hyperparathyroidism

4. Congenital hyperparathyroidism

The correct answer is: Tertiary hyperparathyroidism

Tertiary hyperparathyroidism develops when there is an autonomous overproduction of parathyroid hormone (PTH) after the resolution of secondary hyperparathyroidism, which often occurs as a compensatory response to chronic renal failure or vitamin D deficiency. In secondary hyperparathyroidism, the parathyroid glands enlarge and produce excess PTH in response to low calcium levels and/or high phosphate levels. However, once the underlying cause, such as renal dysfunction, is corrected, for instance through kidney transplantation or effective treatment of vitamin D deficiency, the parathyroid glands may not revert to normal function. Instead, they continue to secrete excessive amounts of PTH autonomously, leading to tertiary hyperparathyroidism. This condition is characterized by elevated calcium levels as a result of the unregulated secretion of PTH. Correct understanding of this process is crucial for managing patients who have undergone treatment for conditions that initially caused secondary hyperparathyroidism. In contrast, primary hyperparathyroidism arises from intrinsic abnormalities of the parathyroid glands themselves, independent of other conditions. Congenital hyperparathyroidism is associated with genetic syndromes, and secondary hyperparathyroidism, as previously mentioned, refers to the gland's compensatory response to