PTH and metabolic disease: SHPT is characterized by inappropriate synthesis and secretion of PTH accompanied by parathyroid cell hyperplasia.[1] Persistence of PTH secretion results in metabolic disorders of calcium (Ca), phosphate(P), and calcitriol, which play a vital role in developing bone disease and vascular calcification.[2] Elevated PTH level is an important trigger for fracture, hyperphosphatemia, anemia, and cardiovascular calcification that worsens the health-related quality of life and increases mortality.[1,3,4]