title: The medical and surgical treatment in secondary and tertiary hyperparathyroidism. Review.
abstract: BACKGROUND
  Hyperparathyroidism is an alteration of the pathophysiological parathyroid hormone (PTH) secretion due or an independent and abnormal release (primary or tertiary hyperparathyroidism) by the parathyroid or an alteration of calcium homeostasis that stimulates the excessive production of parathyroid hormone (secondary hyperparathyroidism).
  
  
  OBJECTIVE
  There is not a standard, clinical or surgical, treatment for hyperparathyroidism. We review current diagnostic and therapeutic methods.
  
  
  CONCLUSIONS
  In secondary hyperparathyroidism (2HPT) there is a progressive hyperplasia of the parathyroid glands and an increased production of parathyroid hormone. Several causes are proposed: chronic renal insufficiency, vitamin D deficiency, malabsorption syndrome. The tertiary hyperparathyroidism (3HPT) is considered a state of excessive autonomous secretion of PTH due to long-standing 2HPT and it's usually the result of a lack of suppression in the production of PTH. The pathophysiological implications are both skeletal and extraskeletal: it damages the cardiovascular system, nervous system, immune, hematopoietic and endocrine system. The introduction of new drugs has improved the survival of these patients, allowing the inhibition of the synthesis of PTH. Indication for surgical treatment is unresponsive medical therapy.
  
  
  CONCLUSIONS
  There are no large prospective studies that comparing the medical and surgical treatment. The choice is not unique and we have to consider the singolar case and the clinical condition of the patient.
authors.affiliation: Azienda Ospedaliera Universitaria Policlinico 'Paolo Giaccone', Palermo.
authors.forename: G
authors.initials: G
authors.lastname: Cocchiara
authors.affiliation: Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo.
authors.forename: S
authors.initials: S
authors.lastname: Fazzotta
authors.affiliation: Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo - Istituto Euromediterraneo di Scienza e Tecnologia (IEMEST), Palermo, Italia.
authors.forename: V D
authors.initials: VD
authors.lastname: Palumbo
authors.affiliation: Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo.
authors.forename: G
authors.initials: G
authors.lastname: Damiano
authors.affiliation: Azienda Ospedaliera Universitaria Policlinico 'Paolo Giaccone', Palermo - Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo.
authors.forename: M
authors.initials: M
authors.lastname: Cajozzo
authors.affiliation: Azienda Ospedaliera Universitaria Policlinico 'Paolo Giaccone', Palermo - Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo.
authors.forename: C
authors.initials: C
authors.lastname: Maione
authors.affiliation: Azienda Ospedaliera Universitaria Policlinico 'Paolo Giaccone', Palermo - Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo.
authors.forename: S
authors.initials: S
authors.lastname: Buscemi
authors.affiliation: Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo.
authors.forename: G
authors.initials: G
authors.lastname: Spinelli
authors.affiliation: Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo.
authors.forename: S
authors.initials: S
authors.lastname: Ficarella
authors.affiliation: Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo.
authors.forename: A
authors.initials: A
authors.lastname: Maffongelli
authors.affiliation: Azienda Ospedaliera Universitaria Policlinico 'Paolo Giaccone', Palermo.
authors.forename: F
authors.initials: F
authors.lastname: Caternicchia
authors.affiliation: Azienda Ospedaliera Universitaria Policlinico 'Paolo Giaccone', Palermo - Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo.
authors.forename: A
authors.initials: A
authors.lastname: Ignazio Lo Monte
authors.affiliation: Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo.
authors.forename: G
authors.initials: G
authors.lastname: Buscemi
mesh_terms: D002118:Calcium / Q000378:metabolism; D006801:Humans; D006961:Hyperparathyroidism / Q000628:therapy*; D006962:Hyperparathyroidism, Secondary / Q000628:therapy*; D006965:Hyperplasia; D010281:Parathyroid Hormone / Q000378:metabolism*
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium
keywords: Medical treatment; Parathormone; Secondary hyperparathyroidism; Surgical treatment; Thertiary hyperparathyroidism