Secondary Hyperparathyroidism
Secondary hyperparathyroidism occurs when the parathyroid glands make too much hormone because of an underlying health issue, most commonly vitamin D deficiency or declining kidney function.
Key Points
- Secondary hyperparathyroidism is more common in women than in men.
- The most common cause is vitamin D deficiency, followed by chronic kidney disease.
- Symptoms include loss of appetite, lack of energy and extreme tiredness, muscle weakness, joint or bone pain.
- Treatment usually includes addressing the underlying cause with medicines.
- If the levels are too high and the underlying cause is kidney disease, your doctor may recommend surgery.
What is secondary hyperparathyroidism?
Secondary hyperparathyroidism occurs when the parathyroid glands make too much parathyroid hormone (PTH) as a response to some other underlying health issue. This condition is more common in women than in men.
What are the symptoms of secondary hyperparathyroidism?
Each person may experience symptoms differently. Symptoms of too much calcium in the blood may include:
- Increased thirst
- Joint pain
- Muscle weakness
- Excess urination
- Lack of energy and extreme tiredness (fatigue)
- Loss of appetite
Other serious symptoms may include:
- Depression
- Memory loss
- Trouble concentrating
- Trouble sleeping
- If you are on dialysis and eligible for kidney transplant, a severely high PTH level may need to be addressed before receiving a new kidney, as it can put you at risk to of losing your kidney graft.
The symptoms of secondary hyperparathyroidism may look like other health problems. Always talk with your healthcare provider for a diagnosis.
What are side effects of secondary hyperparathyroidism?
High levels of PTH can lead to:
- bone density loss
- poor energy levels
- muscle aches
- Fractures
- Trouble concentrating or remembering things
How do the parathyroid glands work?
The parathyroid glands are small glands that sit behind the thyroid in the center of the neck. Occasionally, one or more parathyroid glands may be in an unusual location in the neck or upper chest region. Most people have four parathyroid glands, but in rare cases there may be a fifth or sixth gland.
Your parathyroid glands make parathyroid hormone (PTH) to keep blood calcium levels from going too low. PTH:
- Releases calcium from bones
- Reabsorbs calcium from the kidney
- Increases how much calcium is absorbed from food
What causes secondary hyperparathyroidism?
There are two common causes of secondary hyperparathyroidism:
- Vitamin D deficiency can occur from malabsorption syndromes, such as celiac disease, or prior surgery that re-routes the intestines, such as a gastric bypass, or medications. When your vitamin D levels are too low, you cannot absorb calcium properly. This causes the levels of calcium in your blood to drop, which triggers the parathyroid glands to produce more PTH.
- Kidney failure, also known as end-stage kidney disease. As chronic kidney disease (CKD) progresses, changes in calcium, phosphorous and vitamin D stimulate the parathyroid glands and cause them to enlarge. By the time people with CKD are on dialysis, a majority will have hyperparathyroidism.
When all the parathyroid glands are making excess PTH, they all enlarge, causing a condition called parathyroid hyperplasia. Parathyroid hyperplasia is noncancerous but can worsen hyperparathyroidism and lead to tertiary hyperparathyroidism.
How is secondary hyperparathyroidism diagnosed?
The condition may not have any symptoms or complications. Sometimes the condition is found during a routine blood test as part of a physical exam. People who are on dialysis have PTH levels checked every 2-4 months.
If routine bloodwork reveals high levels of PTH, you'll likely have additional blood tests done to re-check the levels of PTH, along with creatinine, phosphorous, calcium and vitamin D.
Your healthcare provider may also request other testing:
- CT Scan
- Ultrasound study of your neck, to find enlarged parathyroid glands
- Dual energy X-ray absorptiometry (DXA scan), to determine bone density and reveal any loss of bone tissue
How is secondary hyperparathyroidism treated?
Treatment will depend on the cause of your hyperparathyroidism. It will also depend on how severe the condition is. Treatment usually includes medicines and treating the underlying cause.
If addressing the underlying cause does not adequately address hyperparathyroidism, surgery to remove the affected glands may be needed. This usually means removing 3.5 of the 4 parathyroid glands.
Medically reviewed by Aarti Mathur, M.D., Ph.D., July 17, 2026
