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Tertiary hyperparathyroidism — SCE Endocrinology MCQ

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HardCalcium/BoneTertiary hyperparathyroidismSCE Endocrinology

A 49-year-old man has persistent hypercalcaemia after renal transplantation. Calcium is 2.94 mmol/L, phosphate 0.62 mmol/L and PTH remains elevated 18 months after transplant. What is the most likely diagnosis?

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Correct answer: D — Tertiary hyperparathyroidism

Persistent autonomous PTH secretion after long-standing CKD and transplantation is tertiary hyperparathyroidism. Vitamin D deficiency alone would not usually cause hypercalcaemia. Treatment may include cinacalcet or parathyroidectomy depending on severity and transplant context.

Reference: KDIGO CKD-MBD Guideline; BNF