A 50-year-old male presents with recurrent nephrolithiasis, generalized bone pain, and fatigue. Serum calcium is 11.8 mg/dL, serum phosphate is 2.1 mg/dL, and intact parathyroid hormone (iPTH) is 145 pg/mL (normal 15-65). What is the primary diagnosis and definitive treatment?

Answer and explanation

Correct answer: D. Primary hyperparathyroidism; Parathyroidectomy

  1. Step 1: Hypercalcemia with inappropriately elevated or non-suppressed iPTH confirms Primary Hyperparathyroidism (PHPT).
  2. Step 2: Most cases (>80-85%) are caused by a solitary benign parathyroid adenoma.
  3. Step 3: Symptomatic PHPT (nephrolithiasis, skeletal osteopenia, renal impairment) is definitively treated by surgical resection of the abnormal gland (parathyroidectomy).
Answer
Primary hyperparathyroidism; Parathyroidectomy.
Why not the others: Secondary hyperparathyroidism features low or normal calcium in chronic kidney disease; malignancy suppresses iPTH.

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