What are the indications for referring a patient with secondary hyperparathyroidism to a specialist?

There is limited direct guidance in the provided UK sources specifically on referral indications for secondary hyperparathyroidism. However, by extrapolating from the management principles of hyperparathyroidism and hypercalcaemia, patients with secondary hyperparathyroidism should be referred to a specialist if they have:

• Persistent or worsening biochemical abnormalities such as elevated parathyroid hormone (PTH) levels despite correction of underlying causes (e.g., chronic kidney disease or vitamin D deficiency) ¹,².
• Complications related to secondary hyperparathyroidism, including bone disease (osteoporosis or fragility fractures) or renal complications (renal stones or impaired renal function) ¹,².
• Severe or symptomatic hypercalcaemia or hyperphosphataemia that requires specialist management ¹.
• Failure to respond to initial management in primary care or if the clinical picture is complex, requiring multidisciplinary input ¹,².

Referral should be made to an endocrinologist or nephrologist with expertise in managing parathyroid disorders and chronic kidney disease, depending on the underlying cause and clinical context ¹,².