Secondary hyperparathyroidism

• Facts:
  Almost a universal finding in patients with ESRD
  Phosphate retention, which begins as the glomerular filtration rate falls, plays a central role in increasing parathyroid hormone by,
  
  1) Inducing hypocalcemia
  2) Hyperphosphatemia directly inhibits calcium sensing receptors on parathyroid glands
  3) Reducing calcium levels by increased formation of calcium phosphate salts
  4) Decreased formation and effect of calcitriol
• Diagnosis:
  Hypocalcemia , hyperphosphatemia
  Increased parathyroid hormone
• Associated With:
  ESRD
• Differential Diagnosis:
  1) Hyperparathyroidism
  2) Albright Hereditary Osteodystrophy (pseudohyperparathyroidism)