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Primary hyperparathyroidism — RCPSC IM MCQ

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ModerateEndocrinologyPrimary hyperparathyroidismRCPSC IM

A 61-year-old woman has fatigue and recurrent kidney stones. Calcium is 2.86 mmol/L on repeat testing, phosphate is low, PTH is elevated, 25-hydroxyvitamin D is sufficient and eGFR is 69 mL/min/1.73 m2. What is the most likely diagnosis?

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Correct answer: C — Primary hyperparathyroidism

Repeated hypercalcemia with inappropriately elevated PTH, low phosphate and nephrolithiasis is most consistent with primary hyperparathyroidism. Familial hypocalciuric hypercalcemia usually has low urinary calcium and often lifelong mild hypercalcemia.

Reference: Canadian endocrine practice; Endocrine Society hypercalcemia guidance