Match each endocrine or renal diagnostic entity with its characteristic laboratory profile involving calcium, phosphorus, and parathyroid hormone (PTH). Assume standard laboratory reference ranges unless otherwise specified.
- Primary hyperparathyroidismElevated serum calcium, elevated intact PTH, decreased serum phosphorus, elevated 24-hour urinary calcium excretion
- Familial hypocalciuric hypercalcemia (FHH)Elevated serum calcium, inappropriately normal or mildly elevated intact PTH, decreased 24-hour urinary calcium excretion
- Humoral hypercalcemia of malignancyElevated serum calcium, suppressed intact PTH, decreased serum phosphorus, elevated PTH-related peptide (PTHrP)
- Secondary hyperparathyroidism (due to chronic kidney disease)Decreased serum calcium, elevated intact PTH, elevated serum phosphorus, low calcitriol
Cevap
Primary hyperparathyroidism features high calcium/PTH with hypercalciuria. FHH features high calcium/PTH with hypocalciuria. Humoral hypercalcemia of malignancy features high calcium, suppressed PTH, and high PTHrP. Secondary hyperparathyroidism in CKD features low calcium, high phosphorus, and high PTH.
The matching correctly pairs each pathophysiological state with its laboratory manifestation. Primary hyperparathyroidism is driven by autonomous PTH secretion causing hypercalcemia, hypophosphatemia, and hypercalciuria. FHH alters the calcium set-point causing hypercalcemia, unsuppressed PTH, and hypocalciuria. Malignancy-associated hypercalcemia suppresses endogenous PTH while PTHrP drives the hypercalcemia. Advanced CKD causes phosphate retention and decreased calcitriol, resulting in hypocalcemia and a secondary rise in PTH.
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Anahtar Kavram
Differential diagnosis of calcium and parathyroid hormone disorders using laboratory parameters including serum phosphorus, urinary calcium, and calcitriol.