Secondary hyperparathyroidism — SCE Endocrinology MCQ

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HardCalcium/BoneSecondary hyperparathyroidismSCE Endocrinology

A haemodialysis patient has corrected calcium 2.18 mmol/L, phosphate 2.3 mmol/L, markedly raised PTH and raised bone-specific alkaline phosphatase. Which process best explains the pattern?

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Correct answer: D — Secondary hyperparathyroidism in advanced chronic kidney disease

The best answer is “Secondary hyperparathyroidism in advanced chronic kidney disease”. Phosphate retention, reduced calcitriol activity and relative hypocalcaemia in kidney failure drive parathyroid hyperplasia and high-turnover bone disease. “Familial hypocalciuric hypercalcaemia with relative hypocalciuria” is less appropriate because familial hypocalciuric hypercalcaemia produces hypercalcaemia rather than this dialysis pattern “Primary hyperparathyroidism with autonomous parathyroid hormone secretion” is less appropriate because primary hyperparathyroidism typically raises calcium and does not explain phosphate retention from renal failure “Hypoparathyroidism with adynamic low-turnover bone disease” is less appropriate because hypoparathyroidism would produce a low PTH concentration “Milk-alkali syndrome following excessive calcium ingestion” is less appropriate because milk-alkali syndrome produces hypercalcaemia with suppressed PTH

Reference: NICE NG203: Chronic kidney disease — assessment and management. https://www.nice.org.uk/guidance/ng203/chapter/Recommendations NICE CG157: Hyperphosphataemia in chronic kidney disease. https://www.nice.org.uk/guidance/cg157/chapter/Recommendations