Question

A 70 y/o male with a 22-year history of chronic kidney disease is at the doctor because he hasn’t been feeling well the past month. He states that his bones hurt, his belly hurts, and he has been feeling depressed as of late. He also mentions that he recently passed a kidney stone this morning and it hurt really badly. An EKG is done, and shows a short ST segment (short QT interval). Labs are ordered.

Labs:
Calcium 12.6 N[8.5-10.5 mg/dl]
PTH 55 N[4-38 pg/mL]
Calcitriol 15 N[100-120 ng/mL]
Which of the following is the best diagnosis?

A)Pseudohypoparathyroidism
B)Primary Hypoparathyroidism
C)Secondary Hyperparathyroidism
D)Primary Hyperparathyroidism

Answer 1

The best diagnosis for the patient is Secondary Hyperparathyroidism, which occurs as a compensatory response to chronic kidney disease. Lab results show an elevated calcium level and increased PTH level, supporting the diagnosis.

Step-by-step explanation:

Based on the provided information, the best diagnosis for the patient is Secondary Hyperparathyroidism. Secondary Hyperparathyroidism occurs as a compensatory response to chronic kidney disease, where there is decreased calcium absorption from the intestines, leading to low serum calcium levels.

In response, the parathyroid gland overproduces parathyroid hormone (PTH) to increase calcium levels, resulting in bone destruction, kidney stone formation, and bone and muscle pain. The elevated calcium level (12.6 mg/dl) and increased PTH level (55 pg/mL) in the patient's lab results support the diagnosis of Secondary Hyperparathyroidism.