A 45-year-old diabetic man has chronic renal failure on peritoneal dialysis for a few years. He takes 1-alfa- cacidol. His blood tests show a calcium 12 mg/dl and PTH is 80 mg/ml. Which of the following is the most likely diagnosis?
سؤال مجاني 5 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة: B. Tertiary hyperparathyroidism
Long-standing CKD causes secondary hyperparathyroidism. When the glands become autonomous, calcium and PTH are both high: this is tertiary hyperparathyroidism. Hypercalcaemia is not a normal finding in dialysis, and primary hyperparathyroidism does not arise from CKD.
ليش كل خيار صح أو غلط
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A
ليش غلط
In long-standing CKD, hypercalcemia is explained by a parathyroid gland secreting PTH regardless of calcium (tertiary), or by calcium-based phosphate binders; with PTH still raised, the drug alone does not explain the picture.
✓ Step Up To Medicine 6th, 2024 (CKD).pdf · p. 3 -
B
ليش صح
Tertiary hyperparathyroidism: after long-standing secondary hyperparathyroidism the gland secretes excess PTH without responding to calcium, so calcium and PTH are both high.
✓ Step Up To Medicine 6th, 2024 (CKD).pdf · p. 3 -
C
ليش غلط
In CKD the usual findings are low calcium and high phosphate; hypercalcemia is only sometimes seen (long-standing hyperparathyroidism, calcium-based binders), so it is not normal.
✓ Step Up To Medicine 6th, 2024 (CKD).pdf · p. 3 -
D
ليش غلط
CKD lowers 1,25-dihydroxy vitamin D, causing hypocalcemia and secondary (not primary) hyperparathyroidism.
✓ Step Up To Medicine 6th, 2024 (CKD).pdf · p. 3
- المصدر
- Step Up To Medicine 6th, 2024 (CKD).pdf · p. 3
3• Parathyroid Disorders [Notes].pdf · p. 3 - المحاضرة
- Parathyroid & Calcium Disorders · Endocrinology · Module B
- ظهر في
- Endo bank