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not of major importance; "played a secondary role in world events"
the defensive football players who line up behind the linemen
being of second rank or importance or value; not direct or immediate; "the stone will be hauled to a secondary crusher"; "a secondary source"; "a secondary issue"; "secondary streams"
belonging to a lower class or rank
depending on or incidental to what is original or primary; "a secondary infection"
excessive secretion of parathyroid hormone resulting in abnormally high levels of calcium in the blood; can affect many systems of the body (especially causing bone resorption and osteoporosis)

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『第2の』,2番目の;(…の)次の《+『to』+『名』》 / 派生的な,二次的な,あまり重要でない / 中等学校[教育]の / 二次電流の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/02/12 00:23:11」(JST)

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Secondary hyperparathyroidism (SHPT) refers to the excessive secretion of parathyroid hormone (PTH) by the parathyroid glands in response to hypocalcemia (low blood calcium levels) and associated hyperplasia of the glands. This disorder is especially seen in patients with chronic kidney failure. It is often—although not consistently—abbreviated as SHPT in medical literature.

Signs and symptoms

Bone and joint pain are common, as are limb deformities. The elevated PTH has also pleiotropic effects on blood, immune system and neurological system.

Diagnosis

The PTH is elevated due to decreased levels of calcium or 1,25-dihydroxy-vitamin D₃. It is usually seen in cases of chronic renal disease or defective calcium receptors on the surface of parathyroid glands.

Cause

Chronic kidney failure is the most common cause of secondary hyperparathyroidism. Failing kidneys do not convert enough vitamin D to its active form, and they do not adequately excrete phosphate. When this happens, insoluble calcium phosphate forms in the body and removes calcium from the circulation. Both processes lead to hypocalcemia and hence secondary hyperparathyroidism. Secondary hyperparathyroidism can also result from malabsorption (chronic pancreatitis, small bowel disease, malabsorption-dependent bariatric surgery) in that the fat-soluble vitamin D can not get reabsorbed. This leads to hypocalcemia and a subsequent increase in parathyroid hormone secretion in an attempt to increase the serum calcium levels.

Treatment

If the underlying cause of the hypocalcemia can be addressed, the hyperparathyroidism will resolve. In people with chronic renal failure, treatment consists of dietary restriction of phosphorus, supplements with an active form of vitamin D such as calcitriol, doxercalciferol, paricalcitol, etc. and phosphate binders which can be divided into calcium-based and non-calcium based.

In the treatment of secondary hyperparathyroidism due to chronic kidney disease on dialysis calcimimetics does not appear to affect the risk of early death.^[1] It does decrease the need for a parathyroidectomy but caused more issues with low blood calcium levels and vomiting.^[1]

Most people with hyperparathyroidism secondary to chronic kidney disease will improve after renal transplantation, but many will continue to have a degree of residual hyperparathyroidism (tertiary hyperparathyroidism) post-transplant with associated risk of bone loss, etc.

Prognosis

If left untreated, the disease will progress to tertiary hyperparathyroidism, where correction of the underlying cause will not stop excess PTH secretion, i.e. parathyroid gland hypertrophy becomes irreversible. In contrast with secondary hyperparathyroidism, tertiary hyperparathyroidism is associated with hypercalcemia rather than hypocalcemia.

References

^ ^a ^b Ballinger, AE; Palmer, SC; Nistor, I; Craig, JC; Strippoli, GF (9 December 2014). "Calcimimetics for secondary hyperparathyroidism in chronic kidney disease patients.". The Cochrane database of systematic reviews 12: CD006254. doi:10.1002/14651858.CD006254.pub2. PMID 25490118.

External links

CRESCENTcme.org - The Critical RolE of Serum Calcium: An Educational Network for Secondary HyperparaThyroidism

UpToDate Contents

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1. 慢性腎疾患を有する透析前の成人患者における二次性副甲状腺機能亢進症およびミネラル
代謝異常の管理 management of secondary hyperparathyroidism and mineral metabolism abnormalities in adult predialysis patients with chronic kidney disease
2. 透析患者における二次性副甲状腺機能亢進症およびミネラル代謝異常の管理 management of secondary hyperparathyroidism and mineral metabolism abnormalities in dialysis patients
3. 原発性副甲状腺機能亢進症の診断および鑑別診断 diagnosis and differential diagnosis of primary hyperparathyroidism
4. Chapter 6G：腎不全におけるカルシウムおよびリン代謝 chapter 6g calcium and phosphate metabolism in renal failure
5. 副甲状腺ホルモン測定およびその臨床応用 parathyroid hormone assays and their clinical use

English Journal

Parathyroid hormone may be an early predictor of low serum hemoglobin concentration in patients with not advanced stages of chronic kidney disease.

Russo D1, Morrone L2, Di Iorio B3, Andreucci M4, De Gregorio MG5, Errichiello C5, Russo L5, Locatelli F6.
Journal of nephrology.J Nephrol.2015 Dec;28(6):701-8. doi: 10.1007/s40620-014-0129-1. Epub 2014 Aug 12.
BACKGROUND: Parathyroid hormone (PTH) has been associated with anemia only in dialysis patients with severe hyperparathyroidism. Whether an association between PTH and hemoglobin also exists in patients with chronic kidney disease not on dialysis (CKD-patients) is still unclear. In this study we eva
PMID 25113067

Patterns of disease in patients at a tertiary referral centre requiring reoperative parathyroidectomy.

McIntyre CJ1, Allen J2, Constantinides VA1, Jackson JE1, Tolley NS1, Palazzo FF1,2.
Annals of the Royal College of Surgeons of England.Ann R Coll Surg Engl.2015 Nov;97(8):598-602. doi: 10.1308/rcsann.2015.0039. Epub 2015 Oct 7.
Introduction Reoperative parathyroidectomy is required when there is persistent or recurrent hyperparathyroidism following the initial surgery (at least 5% of parathyroidectomies nationally). By convention, 'persistent disease' is defined as the situation where the patient has not been cured by the
PMID 26444799

Japanese Journal

Combination Therapy of Denosumab and Calcitriol for a Renal Transplant Recipient with Severe Bone Loss due to Therapy-Resistant Hyperparathyroidism

The Tohoku Journal of Experimental Medicine 238(3), 205-212, 2016
NAID 130005131609

Patients with normocalcemic primary hyperparathyroidism may have similar metabolic profile as hypercalcemic patients

Endocrine Journal 63(2), 111-118, 2016
NAID 130005127187

Patients with normocalcemic primary hyperparathyroidism may have similar metabolic profile as hypercalcemic patients

Endocrine Journal advpub(0), 2015
NAID 130005109823

Related Pictures

★リンクテーブル★

リンク元	「続発性副甲状腺機能亢進症」
関連記事	「secondary」「hyperparathyroidism」

「続発性副甲状腺機能亢進症」

Secondary hyperparathyroidism
	Thyroid and parathyroid.
Classification and external resources
Specialty	Endocrinology
ICD-10	E21.1
ICD-9-CM	252.02, 588.81
DiseasesDB	6301
MedlinePlus	000318
MeSH	D006962
	[edit on Wikidata]

　　[★]

英: secondary hyperparathyroidism 2HPT
同: 二次性副甲状腺機能亢進症, secondary hyperparathyroidism
関: 副甲状腺機能亢進症

「secondary」

　　[★]

adj.

(地位・価値・重要性などが)第2の、2番目の、(～の)次の(to)。二次的な、従位の

Postmortem examination of patients with such obstructions without a history of clinical manifestations of myocardial ischemia often shows macroscopic scars secondary to MI in regions supplied by diseased coronary arteries, with or without collateral circulation.

in the past the commonest cause of death has been venous thrombosis followed by infection secondary to severe neutropenia and hemorrhage secondary to severe thrombocytopenia.(HIM.661)(重度の好中球減少に次ぐ感染と血小板減少に次ぐ出血に続発する静脈血栓症が昔の最も一般的な死因であった)

副次的な(発生などが)派生的な

「hyperparathyroidism」

　　[★] 副甲状腺機能亢進症

[Cochrane2014-1] Ballinger, AE; Palmer, SC; Nistor, I; Craig, JC; Strippoli, GF (9 December 2014). "Calcimimetics for secondary hyperparathyroidism in chronic kidney disease patients.". The Cochrane database of systematic reviews 12: CD006254. doi:10.1002/14651858.CD006254.pub2. PMID 25490118.

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案内

secondary hyperparathyroidism