Match each patient's clinical vignette and laboratory profile to the most accurate underlying pathophysiologic mechanism describing their calcium and bone metabolism disorder.
- A 58-year-old woman with recurrent nephrolithiasis and constipation. Labs show calcium 11.4 mg/dL, phosphorus 2.3 mg/dL, and intact PTH 105 pg/mL.Autonomous monoclonal proliferation of parathyroid chief cells
- A 45-year-old woman with perioral tingling and carpopedal spasm 48 hours after a total thyroidectomy. Labs show calcium 7.4 mg/dL, phosphorus 5.6 mg/dL, and intact PTH 8 pg/mL.Iatrogenic removal or vascular compromise of parathyroid tissue
- A 70-year-old housebound man with bone pain and proximal muscle weakness. Labs show calcium 8.2 mg/dL, phosphorus 2.1 mg/dL, and intact PTH 145 pg/mL.Severe deficiency of cholecalciferol leading to impaired intestinal calcium absorption
- A 62-year-old man with fatigue, pruritus, and an eGFR of 12 mL/min/1.73 m . Labs show calcium 7.8 mg/dL, phosphorus 7.1 mg/dL, and intact PTH 410 pg/mL.Loss of functioning nephrons causing impaired phosphate excretion and decreased calcitriol synthesis
Cevap
The correct matches are: the nephrolithiasis patient to autonomous proliferation (Primary Hyperparathyroidism), the post-thyroidectomy patient to iatrogenic removal (Hypoparathyroidism), the housebound patient to cholecalciferol deficiency (Vitamin D deficiency), and the patient with a low eGFR to loss of functioning nephrons (CKD-MBD).
Calcium and phosphate homeostasis is strictly regulated by PTH and Vitamin D. Correctly matching these scenarios requires analyzing the direction of calcium and phosphorus derangements alongside the PTH response (compensatory vs. autonomous).
Adım Adım Çözüm
Anahtar Kavram
Evaluation of calcium and phosphate disorders using intact parathyroid hormone (PTH) levels and clinical context.
Tahmini Süre:1m 30s