Tertiary hyperparathyroidism is -

Ans. is 'a' i.e., Autonomous state due to monoclonal outgrowth of previously hyperplastic parathyroid glands * Tertiary Hyperparathyroidism: It is the name given to persistent hypersecretion of PTH even after the cause of prolonged hypocalcemia is corrected.* Parathormone hypersecretion no longer responsive to medical therapy, a state of severe hyperparathyroidism in patients with renal failure that requires surgery, has been referred to as tertiary hyperparathyroidism.* Parathyroid surgery is necessary to control this condition. Based on genetic evidence from examination of tumor samples in these patients, the emergence of autonomous parathyroid function is due to a monoclonal outgrowth of one or more previously hyperplastic parathyroid glands.* The adaptive response has become an independent contributor to disease; this finding seems to emphasize the importance of optimal medical management to reduce the proliferative response of the parathyroid cells that enables the irreversible genetic change.* Parathyroid glands in tertiary hyperthyroidism are larger and degenerative changes are more common.