Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo.
Clin Ter. 2021 May 5;172(3):241-246. doi: 10.7417/CT.2021.2322.
Tertiary hyperparathyroidism (HPT III) occurs when an excess of parathyroid hormone (PTH) is secreted by parathyroid glands, usually after longstanding secondary hyperparathyroidism. Some authorities reserve the term for secondary hyperparathyroidism that persists after successful renal transplantation. Long-standing chronic kidney disease (CKD) is associated with several metabolic disturbances that lead to increased secretion of PTH, including hyperphosphatemia, calcit-riol deficiency, and hypocalcaemia. Hyperphosphatemia has a direct stimulatory effect on the parathyroid gland cell resulting in nodular hyperplasia and increased PTH secretion. Prolonged hypocalcaemia also causes parathyroid chief cell hyperplasia and excess PTH. Af-ter correction of the primary disorder CKD by renal transplant, the hypertrophied parathyroid tissue fails to resolute, enlarge over and continues to oversecrete PTH, despite serum calcium levels that are within the reference range or even elevated. They also may become resistant to calcimimetic treatment. The main indication for treatment is persistent hypercalcemia and/or an increased PTH, and the primary treatment is surgery. Three procedures are commonly performed: total parathyroidectomy with or without autotransplantation, subtotal parathyroidectomy, and limited parathyroidectomy. It is important to remove superior parts of thymus as well. The most appropriate surgical procedure, whether it be total, subtotal, or anything less than subtotal including "limited" or "focused" parathyroidectomies, continues to be unclear and controversial. Surgical complications are rare, and para-thyroidectomy appears to be a safe and feasible treatment option for HPT III.
三发性甲状旁腺功能亢进症（HPT III）是指甲状旁腺分泌过多甲状旁腺激素（PTH），通常发生在长期继发性甲状旁腺功能亢进之后。一些权威机构将该术语保留给成功肾移植后持续存在的继发性甲状旁腺功能亢进。长期慢性肾脏病（CKD）与多种代谢紊乱相关，这些紊乱会导致 PTH 分泌增加，包括高磷血症、活性维生素 D 缺乏和低钙血症。高磷血症对甲状旁腺细胞有直接刺激作用，导致结节性增生和 PTH 分泌增加。长时间低钙血症也会导致甲状旁腺主细胞增生和 PTH 过量。在通过肾移植纠正 CKD 的主要疾病后，尽管血清钙水平在参考范围内甚至升高，增生的甲状旁腺组织仍无法恢复正常，继续过度分泌 PTH。它们也可能对钙敏感受体治疗产生抗性。治疗的主要指征是持续高钙血症和/或 PTH 升高，主要治疗方法是手术。通常进行三种手术：甲状旁腺全切除加或不加自体移植、甲状旁腺次全切除和甲状旁腺部分切除。切除胸腺上部也很重要。最适当的手术方式，无论是全切除、次全切除还是小于次全切除的手术，包括“有限”或“聚焦”甲状旁腺切除术，仍然不清楚和有争议。手术并发症罕见，甲状旁腺切除术似乎是 HPT III 的安全可行的治疗选择。
