PTH and metabolic syndrome: Management must therefore integrate targeted metabolic and cardiovascular measures—rigorous blood-pressure control, correction of anemia, treatment of dyslipidemia—alongside therapies directed at mineral metabolism, including vitamin D analogues, calcimimetics (cinacalcet, etelcalcetide, upacicalcet) and phosphate-lowering strategies; these interventions can favorably modify PTH levels, parathyroid gland volume and bone structure, but require careful monitoring for hypocalcemia and vascular calcification.