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CAMLPR Evaluation And Interpretation Competency Practice Test

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Lab tests on a patient with bone pain, recurrent kidney stones, abdominal discomfort and fatigue show Serum Mg 2.20 mmol/L, Ca 2.80 mmol/L, Phosphorus 0.70 mmol/L; Urine Ca INC, Urine Phos INC. What is the cause?
Correct Answer:
Hyperparathyroidism
Explanation:
Elevated calcium with low phosphate and urinary calcium and phosphate loss points to excess parathyroid hormone activity on bone and kidney. In primary hyperparathyroidism, one gland overproduces PTH, often from an adenoma. PTH drives bone resorption and increases calcium reabsorption in the kidney while causing phosphate wasting. The result is high serum calcium, low serum phosphate, and hypercalciuria, which explains the kidney stones and bone pain. The other conditions don’t fit this pattern: hypoparathyroidism would lower calcium and raise phosphate; secondary hyperparathyroidism usually has low or normal calcium with high PTH in CKD; pseudohyperparathyroidism has high PTH with low calcium due to PTH resistance. Thus, the cause is primary hyperparathyroidism.

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