A 38-Year-Old Man With Back and Side Pain*
A 38-year-old man presents to the emergency department (ED) with pulsatile right-sided back and side pain that has been radiating to his groin for the past three hours. He was sitting on his couch at home when the pain began, and it has gotten progressively worse. He denies any recent trauma.
A review of systems is significant for constipation, feelings of depression, and pain in each of his limbs. His temperature is 98.6°F (37°C), pulse is 78 beats/min, respirations are 16 breaths/min, and blood pressure is 138/84 mm Hg. The patient rates the pain as a 9 on a 10-point scale.
Complete metabolic panel shows a serum calcium of 11.2 mg/dL and phosphate of 12 U/L. Urine analysis revealed microscopic hematuria. An abdominal CT scan demonstrated calcification within the kidney parenchyma bilaterally in addition to nephrolithiasis (see image).
Which of the following is the most likely cause of this condition?
D. Primary hyperparathyroidism
E. Secondary hyperparathyroidism
Answer to be disclosed shortly
*The present case appears in Medscape