Case history
Case history #1
A 50-year-old obese woman with long-standing, poorly controlled diabetes mellitus presents with lethargy and fatigue. Screening labs report that she has a creatinine level of 190.6 micromol/L (2.5 mg/dL) and a urea level of 14.3 nanomol/L (40 mg/dL). Additional labs are ordered, which reveal a calcium level of 1.85 mmol/L (7.4 mg/dL) and a phosphorus level of 1.9 mmol/L (5.9 mg/dL). The parathyroid hormone level is 400 nanograms/L (400 picograms/mL).
Case history #2
An 85-year-old female nursing-home patient is being seen for post-menopausal skeletal disease that has become a concern after she fell and broke her wrist. Her bone densitometry reveals osteoporosis (T-score: -3.5). Lab tests return with a calcium level of 2.2 mmol/L (8.8 mg/dL) and a parathyroid hormone level of 120 nanograms/L (120 picograms/mL). These results prompt vitamin D testing that returns a 25-hydroxyvitamin D level of 14 nanograms/mL.
Other presentations
The disease most frequently associated with secondary hyperparathyroidism (SHPT) is chronic kidney disease. However, the most common reason for SHPT is vitamin D deficiency, which is most often encountered among older patients, those with fat malabsorption syndromes, or those with limited exposure to sunlight.[2]
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