Symptoms:

Symptoms generally relate to the underlying cause of secondary hyperparathyroidism.

In children, rickets may cause the following:

• Weakness
• Poor growth
• Bowed limbs
• Swollen joints
• Bone pain and fractures
• Delayed tooth development

Patients with kidney failure may have osteomalacia, osteoporosis, or both. Bone pain or fractures may occur.

Symptoms of malabsorption (such as diarrhea) or of an underlying cancer may occur in patients with those disorders.

Signs and tests:

Signs may include bone deformities, swollen joints, or fractures.

Tests may show:

• Elevated intact PTH
• Low serum calcium
• Abnormal serum phosphorus levels
  • Low -- if due to absorption problems
  • High -- if due to kidney failure
• Elevated serum alkaline phosphatase
• Variable vitamin D levels
• X-rays may show evidence of osteomalacia, fractures, or bone resorption (breakdown)
• Low bone mineral density
• Abnormal urine calcium levels
  • Low -- if the problem is with absorption in the gut
  • High -- if the problem is with the kidneys