A 58-year-old woman presents with recurrent nephrolithiasis and progressive diffuse bone pain. Vital signs: BP 138/82, HR 88, RR 16, Temp 37.2°C, SpO2 98%. Laboratory studies reveal serum calcium 11.2 mg/dL (normal 8.5-10.5), phosphate 2.1 mg/dL (normal 2.5-4.5), and PTH 145 pg/mL (normal 15-65). Urine calcium is elevated. Recent DEXA scan shows decreased bone mineral density. She denies recent thiazide diuretic use. Which of the following is the most likely diagnosis?
- A)Primary hyperparathyroidismGABARITO
- B)Secondary hyperparathyroidism due to chronic kidney disease
- C)Vitamin D deficiency
- D)Hypoparathyroidism after thyroid surgery
- E)Pseudohypoparathyroidism
Explicação
Primary hyperparathyroidism is usually caused by a parathyroid adenoma and classically causes hypercalcemia, hypophosphatemia, nephrolithiasis, and bone resorption. PTH increases renal phosphate wasting and stimulates osteoclast mediated bone turnover through ... Ver explicação completa e trilha adaptativa →