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Biochemical differentiation between primary, secondary and tertiary hyperparathyroidism
| Biochemical Parameter | Primary hyperparathyroidism | Secondary hyperparathyroidism | Tertiary hyperparathyroidism |
|---|---|---|---|
| Calcium | ↑ | ↓ | ↑ |
| phosphate | ↓ | ↑* | ↑ |
| iPTH | ↑ | ↑ | ↑ |
*N.B. SHP in patients with normal renal function (unlike as in those with CKD) is usually associated with low levels of phosphate given the inhibitory effect of PTH on Sodium-Phosphate co-transporters in the renal tubules
