skip to main content

Primary Hyperparathyroidism — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRenal Stone DiseasePrimary HyperparathyroidismESENeph

A 52-year-old man presents with recurrent calcium oxalate kidney stones. 24-hour urine shows: calcium 9.2 mmol/day (elevated), oxalate normal, citrate low, volume 1.2 L/day. Serum calcium is 2.55 mmol/L, PTH 8.5 pmol/L (reference 1.6-6.9). What is the underlying diagnosis?

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

Reveal the answer and explanation

Correct answer: A — Primary hyperparathyroidism

Elevated serum calcium with elevated PTH indicates primary hyperparathyroidism (PHPT) as the cause of hypercalciuria and recurrent calcium stones. In idiopathic hypercalciuria, serum calcium and PTH would be normal. In RTA type 1, serum calcium is normal but urinary citrate is low and pH is high. Sarcoidosis causes hypercalcaemia with suppressed PTH. PHPT should be confirmed and surgical referral made.

Reference: NICE NG132 2019 – Hyperparathyroidism; EAU 2024 – Urolithiasis Guidelines