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The system exerts its influence via release or inhibition of vasopressin (antidiuretic hormone, ADH) which acts on the kidney to decrease water excretion. Deficiency of ADH is usually due to hypothalamic-neurohypophyseal lesions (central diabetes insipidus) or insensitivity of the kidney to ADH (nephrogenic diabetes insipidus). These patients, if untreated, have the predictable result of dehydration, hyperosmolality, hypovolemia, and eventual death in severe cases.
There are many causes of secondary hyperparathyroidism and it can occur in any condition that causes chronic hypocalcaemia. The commonest cause is chronic kidney disease but may also include vitamin D deficiency from lack of sunlight exposure or malabsorption of vitamin D (small bowel disease, pancreatic disease etc).