QuestionSBA
QuestionChoice
Secondary hyperparathyroidism is caused by a physiological increase in PTH secretion in response to low calcium levels. The low calcium is typically attributed to kidney, liver, or bowel disease. The calcium levels in this patient are raised, which makes this diagnosis incorrect.
10006858
c
Secondary hyperparathyroidism
QuestionChoice
Addison's disease may also present with fatigue and low mood, but hypercalcaemia is a rare finding. Patients may also have increased pigmentation, and blood tests typically demonstrate hyperkalaemia and hyponatraemia.
10006859
d
Addison's disease
QuestionChoice
Primary hyperparathyroidism is most commonly caused by a parathyroid adenoma, which secretes excess parathyroid hormone (PTH), leading to hypercalcaemia. Hypercalcaemia is typically the cause of symptoms in hyperparathyroidism which include bone pain, fatigue, renal stones, and GI upset - which can be remembered as 'stones, moans, bones, groans'. This patient has elevated serum calcium and low phosphate, and an inappropriately high PTH based on these results. PTH may be within normal ranges in primary hyperparathyroidism, as they would normally fall in a patient with hypercalcaemia.
10006856
a
Primary hyperparathyroidism
QuestionChoice
Sarcoidosis can result in a transient hypercalcaemia, but it is less likely to be the primary cause of the patient's symptoms. Patients with sarcoidosis would typically present with a dry cough, shortness of breath, and non-pulmonary features such as erythema nodosum.
10006857
b
Sarcoidosis
QuestionChoice
Multiple myeloma is an important differential diagnosis in patients with hypercalcaemia. However, back pain is the most common presentation. Patients will commonly also have renal impairment (raised Cr), anaemia, and bone lesions. PTH would be expected to be low in myeloma as a physiological response to hypercalcaemia.
10006860
e
Multiple myeloma
Concept
Chapter
2693
4548
Hyperparathyroidism
Topic
133
Endocrinology
13918
A 55-year-old lady presents to her GP with fatigue, low mood, and generalised bone pains. She had an episode of renal colic one week ago which resolved without medical intervention. She has a past medical history of hypertension and currently takes ramipril. She has a 15 pack-year history of smoking.
Blood tests show: 


|                    |    |        |
| --------------------------- | :-------: | -------------------- |
| Calcium                     | 2.93 mmol/L          | 2.2 - 2.6     |
| Phosphate                   | 0.69 mmol/L          | 0.8 - 1.5     |
| Parathyroid Hormone         | 6.9 pmol/L          | 1.6 - 8.5                |
| Sodium                      | 142 mmol/L          | 135 - 145     |
| Potassium                   | 4.0 mmol/L          | 3.5 - 5.3     |
| Creatinine                  | 94 µmol/L          | 60 - 120      |


What is the most likely diagnosis?
a