A 50-year-old woman presents to the Emergency room with a decreased level of consciousness and history of bone pain, generalized malaise, and constipation. On examination, she looks ill and disoriented with signs of volume depletion. Her labs show ESR 40, serum calcium 13mg/dl, Albumin 3.6g/L, phosphate 2.0mg/dl, creatinine 0.9mg/dl and PTH 75. Which of the following is the most likely cause of this patient's hypercalcemia?
سؤال مجاني 3 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة والشرح
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الإجابة: B. Primary hyperparathyroidism
High calcium (13), low phosphate and a high, unsuppressed PTH (75) with normal creatinine is primary hyperparathyroidism. In cancer-associated hypercalcaemia PTH would be suppressed. Secondary HPT has low or normal calcium, and tertiary HPT needs long-standing CKD with high phosphate.
ليش كل خيار صح أو غلط
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A
ليش غلط
In the approach chart, the malignancy work-up (PTHrP) sits on the PTH-low branch; this patient's PTH is not suppressed (75), so cancer-related hypercalcemia is not favoured.
✓ Calcium and Parathyroid.pdf · p. 49 -
B
ليش صح
In hypercalcemia the PTH should be suppressed, so a PTH that is elevated or inappropriately normal (75) with high calcium and low phosphate is primary hyperparathyroidism.
✓ Step Up To Medicine 6th Edition 2024(Parthyroid).pdf · p. 4 -
C
ليش غلط
Secondary hyperparathyroidism has low or normal calcium (and high/normal phosphate); this patient's calcium is high and phosphate low.
✓ Calcium and Parathyroid.pdf · p. 51 -
D
ليش غلط
Tertiary hyperparathyroidism has high calcium with high phosphate; this patient's phosphate is low (2.0), the primary pattern.
✓ Calcium and Parathyroid.pdf · p. 51
- المصدر
- Calcium and Parathyroid.pdf · p. 51
Step Up To Medicine 6th Edition 2024(Parthyroid).pdf · p. 4 - المحاضرة
- Parathyroid & Calcium Disorders · Endocrinology · Module B
- ظهر في
- Endo bank