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We report the development of tertiary hyperparathyrodism in a patient with a sporadic form of adult-onset hypophosphataemic osteomalacia who had been treated with vitamin D or calcitriol and large doses of phosphate. This observation suggests that even with concomitant vitamin D or calcitriol therapy, long-term oral phosphate supplementation may lead to the development of hypercalcaemic hyperparathyrodism. Caution is recommended when relatively large doses of phosphate are used to treat hypophosphataemic osteomalacia of diverse causes.

TERTIARY HYPERPARATHYROIDISM AFTER LONG-TERM PHOSPHATE SUPPLEMENTATION IN ADULT-ONSET HYPOPHOSPHATAEMIC OSTEOMALACIA