A 52-year-old patient has just passed a kidney stone and has high levels of calcium in her urine. Blood tests show high levels of calcium in her blood as well
What subsequent lab results would be most likely to distinguish between primary hyperparathyroidism and hypercalcemia of malignancy?
A)
Parathyroid hormone level
B)
Bone scan
C)
Plasma phosphate levels
D)
Serum magnesium level
Ans:
A
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Hyperparathyroidism, in which parathyroid hormone is secreted in excess, may be caused by a parathyroid adenoma. Since parathyroid hormone mobilizes calcium from bone and promotes its transfer to the extracellular fluid, excess calcium is excreted in the urine (promoting the development of kidney stones) and is evident in the plasma. In primary hyperparathyroidism, antibody binding assays of intact PTH would reveal either normal or elevated parathyroid hormone in the face of hypercalcemia, whereas in hypercalcemia of malignancy, levels of intact PTH are suppressed.
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