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Primary hyperparathyroidism — SCE Endocrinology MCQ

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EasyCalcium/BonePrimary hyperparathyroidismSCE Endocrinology

A 72-year-old woman is investigated after a low-trauma distal radius fracture. Calcium is 2.91 mmol/L, phosphate 0.65 mmol/L, PTH 14.8 pmol/L and 25-hydroxyvitamin D is 62 nmol/L. Creatinine is normal. What is the most likely diagnosis?

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Correct answer: B — Primary hyperparathyroidism

Primary hyperparathyroidism is best because hypercalcaemia with inappropriately elevated PTH and low phosphate is most consistent with primary hyperparathyroidism. The alternatives are less appropriate because FHH usually has low urinary calcium and lifelong mild disease; vitamin D deficiency rarely causes hypercalcaemia; malignancy suppresses PTH; tertiary disease follows advanced CKD. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE CKS Hyperparathyroidism; Society for Endocrinology