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Primary hyperparathyroidism — RACP Adult Medicine MCQ

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ModerateEndocrinology and diabetesPrimary hyperparathyroidismRACP Adult Medicine

A 62-year-old woman is found to have calcium 2.86 mmol/L on routine testing. Phosphate is low, PTH is inappropriately elevated and eGFR is normal. She has recurrent renal stones. What is the most likely diagnosis?

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Correct answer: C — Primary hyperparathyroidism

Hypercalcaemia with inappropriately elevated PTH and low phosphate is typical of primary hyperparathyroidism. Malignancy usually suppresses PTH. Vitamin D deficiency and hypoparathyroidism do not cause this pattern, and milk-alkali syndrome would not elevate PTH.

Reference: Therapeutic Guidelines (eTG) Endocrinology; AMH