In secondary hyperparathyroidism, high levels of PTH occur as a compensation for hypocalcemia rather than as a primary abnormality of the parathyroid glands. This contrasts with primary hyperparathyroidism, which is associated with hypercalcemia.
Secondary hyperparathyroidism can be caused by vitamin D deficiency or chronic renal disease in which the damaged kidneys are unable to produce sufficient amounts of the active form of vitamin D, 1,25-dihydroxycholecalciferol. As discussed in more detail in the next section, the vitamin D deficiency leads to osteo-malacia (inadequate mineralization of the bones), andhigh levels of PTH cause absorption of the bones.
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