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Hypoparathyroidism — SCE Rheumatology MCQ

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HardMetabolic Bone DiseaseHypoparathyroidismSCE Rheumatology

A patient with chronic postsurgical hypoparathyroidism takes calcitriol and calcium. Symptoms have resolved, but adjusted calcium is high-normal and 24-hour urinary calcium is elevated. What therapeutic target is preferable?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Reduce therapy towards low-normal calcium and reassess urinary calcium

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · C = shown as D

B is correct. Conventional therapy aims for freedom from hypocalcaemic symptoms at a calcium in the lower reference range or slightly below, while avoiding hypercalciuria, hyperphosphataemia and renal complications. A ignores renal exposure. C worsens phosphate burden. D removes the therapy that replaces deficient renal activation. E deliberately creates treatment toxicity.

Reference: Revised European Society of Endocrinology guideline for chronic hypoparathyroidism: https://academic.oup.com/ejendo/article/193/5/G83/8321487