QuestionSBA
QuestionChoice
The results in this case would show an elevated calcium, phosphate and PTH. Tertiary hyperparathyroidism often results from secondary hyperparathyroidism, as the parathyroid glands are chronically hyper-stimulated.
10028368
c
Tertiary hyperparathyroidism
QuestionChoice
The history is describing symptoms suggestive of hypercalcaemia. In most people with Primary Hyperparathyroidism, both calcium and parathyroid are higher than normal. Occasionally, a patient may have an elevated calcium level and a normal or minimally elevated PTH level. Since PTH should be low when calcium is elevated, a normal or minimally elevated PTH is considered abnormal and usually indicates Primary hyperparathyroidim as if the normal feedback loop was maintained, the PTH should be suppressed.
10028366
a
Primary hyperparathyroidism
QuestionChoice
Osteomalacia is a defect of bone mineralisation secondary to vitamin D deficiency. A low calcium and low phosphate would be seen in osteomalacia, and it would be unlikely to present with renal stones.
10028370
e
Osteomalacia
QuestionChoice
The results in this case would show hypocalcaemia and a raised phosphate and an (appropriately) raised PTH. This is usually due to decreased production of active vitamin D (e.g. in CKD).
10028367
b
Secondary hyperparathyroidism
QuestionChoice
This would be rare to see in this patient age group and would not present with any of the symptoms of hypercalcaemia listed above. Additionally, the bone profile is typically normal in osteoporosis.
10028369
d
Osteoporosis
QuestionComment
why is she getting flank pain?
43569
QuestionComment
I was wondering this too, made me think maybe underlying kidney disease -> CKD -> Tertiary hyperparathyroidism. Maybe it was just a red herring to try and push you towards tertiary rather than primary?
43584
User
subscriber
Migraine Body
QuestionComment
Trying to get at renal stone given high calcium 
43689
User
subscriber
test123
QuestionComment
Hypercalcaemia =
Bones = bone pain
Stones = renal stones
Groans = discomofrt
Moans = psychiatric moans (confusion)
58626
User
subscriber
Relapse Retrograde
User
subscriber
Ale
QuestionComment
Answer is incorrect. It should be ectopic hyperparathyrodism due to renal cell carcinoma (1 year of flank pain and haematuria).
60934
QuestionComment
Sounds like haematuria and flank pain are new, it’s the symptoms of hypercalacaemia that she’s had for a year 
61494
User
subscriber
Migraine Nightshift
User
subscriber
Sydney Sweeney
Concept
Chapter
2693
6057
Primary hyperparathyroidism
Topic
133
Endocrinology
18071
Primary hyperparathyroidism is a condition where one or more parathyroid glands produce excess parathyroid hormone (PTH), leading to elevated calcium levels in the blood (hypercalcemia), low phosphate levels, and associated symptoms such as fatigue, kidney stones, and bone pain.
A 23-year-old female has flank pain and haematuria. She mentions she has been experiencing fatigue, bony pain and generalised abdominal pain for the last year.


Her blood results show:

||||
|---------------------------|:-------:|------------------------------|
|Calcium|3.2 mmol/L|2.2 - 2.6|
|Phosphate|0.55 mmol/L|0.8 - 1.5|
|Parathyroid Hormone|62 pmol/L|1.6 - 8.5|


What is the most likely underlying diagnosis?
a