The calcium and parathyroid hormone

An elder adult patient with a history of chronic kidney disease has been undergoing dialysis for several years. Recent blood tests now show elevated calcium and parathyroid hormone (PTH) levels consistent with tertiary hyperparathyroidism. How is this condition defined?

Autonomous parathyroid activity due to parathyroid adenomas

Increased parathyroid activity in response to low serum calcium levels

Autonomous parathyroid activity due to secondary hyperplasia of the parathyroid glands

Increased parathyroid activity in response to vitamin D deficiency