PTH and Marchiafava-Bignami disease: Excess levels of PTH are associated with systemic toxicity, known as CKD-mineral and bone disorder (CKD-MBD), which represents the cardiovascular and bone diseases.[3,4] SHPT has typically been treated with the administration of active form of vitamin D to reduce PTH levels[5,6]; however, this type of treatment has been associated with elevations in serum calcium and phosphate levels through stimulating gastrointestinal absorption, in addition, which will cause arterial calcifcation[3] and therefore only a few patients were able to achieve the recommended therapeutic targets.[7]