A 49-year-old woman with end-stage kidney disease underwent successful renal transplantation two years ago. She now presents with fatigue and polyuria. Vital signs: BP 148/92, HR 88, RR 16, Temp 37°C. Laboratory studies reveal calcium 11.2 mg/dL, phosphate 3.1 mg/dL, and markedly elevated PTH at 892 pg/mL. Serum creatinine is normal. Parathyroid ultrasound shows gland enlargement. She denies medication non-adherence. Which of the following best explains her persistent hypercalcemia and elevated PTH?
- A)Autonomous parathyroid hyperplasia after chronic stimulationGABARITO
- B)Parathyroid hormone related peptide secretion by a malignancy
- C)Resistance of target tissues to parathyroid hormone
- D)Accidental removal of the parathyroid glands during surgery
- E)Vitamin D intoxication
Explicação
Tertiary hyperparathyroidism occurs when chronically stimulated parathyroid glands become autonomous after long standing secondary hyperparathyroidism. These glands continue to secrete excess PTH even after the original cause, such as kidney failure, has impro... Ver explicação completa e trilha adaptativa →