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Effect of phosphate on the parathyroid gland: direct and indirect?

Hyperparathyroidism is a common finding in patients with renal failure. Phosphorus retention is known to be an important factor in the development of secondary hyperparathyroidism. Exciting new work has demonstrated that a high extracellular phosphorus concentration directly stimulates parathyroid hormone secretion and synthesis. Dietary phosphorus also modulates parathyroid function indirectly by decreasing calcitriol production, and it interferes with the calcaemic response to parathyroid hormone. The information available suggests that the control exerted by phosphorus is critical, via indirect and direct actions, in preventing the development of secondary hyperparathyroidism.