A 68-year-old woman with no significant past medical history presents with confusion, nausea, and nephrolithiasis. Vital signs show BP 138/82 mmHg, HR 88/min, RR 16/min, temperature 37.2°C. Laboratory studies reveal serum calcium 12.1 mg/dL, phosphate 2.0 mg/dL, PTH 145 pg/mL, and 24-hour urine calcium 320 mg/day. Imaging shows a 4-mm stone in the right ureter. Renal function is normal. Which is the most appropriate next diagnostic step?
- A)24-hour urine calcium excretion
- B)Bone marrow biopsy
- C)Parathyroid imaging with sestamibi scan or ultrasoundGABARITO
- D)PTHrP level
- E)Serum 1,25-dihydroxyvitamin D level
Explicação
This patient has primary hyperparathyroidism confirmed by elevated serum calcium, suppressed phosphate, and elevated PTH. Parathyroid imaging with sestamibi scan or ultrasound is the next diagnostic step to localize the abnormal parathyroid tissue before surgi... Ver explicação completa e trilha adaptativa →