# Management of Primary and Secondary Hyperparathyroidism in a Patient With Chronic Kidney Disease (CKD)

## TL;DR

This paper discusses the complex treatment of a patient with both primary and secondary hyperparathyroidism due to chronic kidney disease.

## Contribution

The novel contribution is a case study demonstrating individualized medical management of coexisting hyperparathyroidism types in CKD.

## Key findings

- The patient was managed medically with cinacalcet and calcitriol due to surgical risks.
- Switching between medications was necessary to address hypocalcemia and recurrent hypercalcemia.
- The case emphasizes the need for close monitoring and guideline-based therapy in complex cases.

## Abstract

An 82-year-old female with stage 4 chronic kidney disease (CKD) presented with asymptomatic hypercalcemia and elevated parathyroid hormone (PTH) levels.

Workup confirmed primary hyperparathyroidism due to a parathyroid adenoma, with secondary hyperparathyroidism due to CKD. Given her age and surgical risk, she was managed medically with cinacalcet, later switched to calcitriol due to hypocalcemia, then reverted to cinacalcet after recurrent hypercalcemia.

This case illustrates the diagnostic and therapeutic challenges of managing coexisting primary and secondary hyperparathyroidism in CKD, highlighting the importance of individualized, guideline-based medical therapy and close biochemical monitoring.