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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{SSK}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
Line 8: Line 8:
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|SubCategory=Endocrine
|SubCategory=Endocrine
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
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|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|SubCategory=Endocrine
|SubCategory=Endocrine
|Prompt=A 43 year old woman presents to the emergency department with acute onset flank pain increasing in severity over the past 2 hours. After initial evaluation, a non-contrast abdominopelvic CT scan reveals 2 small, 1 cm stones lodged at the left ureteropelvic junction. The patient expresses her frustration explaining that this is the fourth time she has been admitted to the hospital for urinary stones in the past 2 months. The complete work-up subsequently reveals a normal creatinine, normal vitamin D levels, with elevated urinary calcium and elevated serum parathyroid hormone. Which of the following additional findings can be expected in this patient?
|Prompt=A 43-year-old woman presents to the emergency department with acute onset flank pain increasing in severity over the past 2 hours. After initial evaluation, a non-contrast abdominopelvic CT scan reveals 2 small, 1 cm stones lodged at the left ureteropelvic junction. The patient expresses her frustration and explains that this is the fourth time she has been admitted to the hospital for urinary stones in the past 2 months. The complete work-up subsequently reveals a normal creatinine, normal vitamin D levels, with elevated urinary calcium and elevated serum parathyroid hormone. Which of the following additional findings can be expected in this patient?
|Explanation=Primary hyperparathyroidism is the most common etiology of elevated serum calcium most often caused by a single functional adenoma excessively secreting parathyroid hormone. Clinically, most patients are asymptomatic with hypercalcemia found incidentally. Other possible presentations include recurrent nephrolithiasis, bone disease, and neuromuscular symptoms. Without proper intervention, frequent nephrolithiasis, decreased bone mineral density, and increased risk of death from cardiovascular causes ensue. Lab findings include hypercalcemia, hypercalciuria, elevated alkaline phosphatase, and elevated PTH. Another finding that can be used in the evaluation is elevated urinary cAMP. Treatment of primary hyperparathyroidism is usually surgical.
|Explanation=Primary hyperparathyroidism is the most common etiology of elevated serum calcium most often caused by a single functional adenoma excessively secreting parathyroid hormone. Clinically, most patients are asymptomatic with hypercalcemia found incidentally. Other possible presentations include recurrent nephrolithiasis, bone disease, and neuromuscular symptoms. Without proper intervention, frequent nephrolithiasis, decreased bone mineral density, and increased risk of death from cardiovascular causes ensue. Lab findings include hypercalcemia, hypercalciuria, elevated alkaline phosphatase, and elevated PTH. Another finding that can be used in the evaluation is elevated urinary cAMP. Treatment of primary hyperparathyroidism is usually surgical.
Edcuational objective: Urinary cAMP is elevated in patients with primary hyperparathyroidism.
References:<br>
Marcocci C, Cetani F. Clinical practice. Primary hyperparathyroidism. N Engl J Med. 2011;365(25):2389-97.<br>
Broadus AE. Nephrogenous Cyclic AMP as a Parathyroid Function Test. Nephron. 1979;23(2-3):136-141.
|AnswerA=Decreased serum calcium
|AnswerA=Decreased serum calcium
|AnswerAExp=Serum calcium is usually elevated in patients with primary hyperparathyroidism.
|AnswerAExp=Serum calcium is usually elevated in patients with primary hyperparathyroidism.
|AnswerB=Decreased alkaline phosphatase levels
|AnswerB=Decreased alkaline phosphatase levels
|AnswerBExp=alkaline phosphatase levels are usually elevated in patients with primary hyperparathyroidism.
|AnswerBExp=Alkaline phosphatase levels are usually elevated in patients with primary hyperparathyroidism.
|AnswerC=Increased urinary cAMP
|AnswerC=Increased urinary cAMP
|AnswerCExp=Increased urinary cAMP levels are another sign of primary hyperparathyroidism.
|AnswerCExp=Increased urinary cAMP levels are another sign of primary hyperparathyroidism.
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|AnswerE=Increased urinary NGAL (neutrophil gelatinase-associated lipocalin)
|AnswerE=Increased urinary NGAL (neutrophil gelatinase-associated lipocalin)
|AnswerEExp=Increase in urinary NGAL (neutrophil gelatinase-associated lipocalin) is also indicative of renal injury and is used in the diagnosis of acute kidney injury.
|AnswerEExp=Increase in urinary NGAL (neutrophil gelatinase-associated lipocalin) is also indicative of renal injury and is used in the diagnosis of acute kidney injury.
|EducationalObjectives=Urinary cAMP is elevated in patients with primary hyperparathyroidism.
|References=Marcocci C, Cetani F. Clinical practice. Primary hyperparathyroidism. N Engl J Med. 2011;365(25):2389-97.<br>
Broadus AE. Nephrogenous Cyclic AMP as a Parathyroid Function Test. Nephron. 1979;23(2-3):136-141.
|RightAnswer=C
|RightAnswer=C
|WBRKeyword=Urinary cAMP, Primary hyperparathyroidism, Hyperparathyroidism, Parathyroid, Hypercalcemia,  
|WBRKeyword=Urinary cAMP, Primary hyperparathyroidism, Hyperparathyroidism, Parathyroid, Hypercalcemia,
|Approved=No
|Approved=Yes
}}
}}

Revision as of 22:12, 6 March 2015
Author [[PageAuthor::Serge Korjian M.D. (Reviewed by Serge Korjian)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathophysiology
Sub Category SubCategory::Endocrine
Prompt [[Prompt::A 43-year-old woman presents to the emergency department with acute onset flank pain increasing in severity over the past 2 hours. After initial evaluation, a non-contrast abdominopelvic CT scan reveals 2 small, 1 cm stones lodged at the left ureteropelvic junction. The patient expresses her frustration and explains that this is the fourth time she has been admitted to the hospital for urinary stones in the past 2 months. The complete work-up subsequently reveals a normal creatinine, normal vitamin D levels, with elevated urinary calcium and elevated serum parathyroid hormone. Which of the following additional findings can be expected in this patient?]]
Answer A AnswerA::Decreased serum calcium
Answer A Explanation AnswerAExp::Serum calcium is usually elevated in patients with primary hyperparathyroidism.
Answer B AnswerB::Decreased alkaline phosphatase levels
Answer B Explanation AnswerBExp::Alkaline phosphatase levels are usually elevated in patients with primary hyperparathyroidism.
Answer C AnswerC::Increased urinary cAMP
Answer C Explanation AnswerCExp::Increased urinary cAMP levels are another sign of primary hyperparathyroidism.
Answer D AnswerD::Increased urinary cystatin C
Answer D Explanation AnswerDExp::Increase in urinary cystatin C is indicative of renal injury and is used in the diagnosis of acute kidney injury.
Answer E AnswerE::Increased urinary NGAL (neutrophil gelatinase-associated lipocalin)
Answer E Explanation AnswerEExp::Increase in urinary NGAL (neutrophil gelatinase-associated lipocalin) is also indicative of renal injury and is used in the diagnosis of acute kidney injury.
Right Answer RightAnswer::C
Explanation [[Explanation::Primary hyperparathyroidism is the most common etiology of elevated serum calcium most often caused by a single functional adenoma excessively secreting parathyroid hormone. Clinically, most patients are asymptomatic with hypercalcemia found incidentally. Other possible presentations include recurrent nephrolithiasis, bone disease, and neuromuscular symptoms. Without proper intervention, frequent nephrolithiasis, decreased bone mineral density, and increased risk of death from cardiovascular causes ensue. Lab findings include hypercalcemia, hypercalciuria, elevated alkaline phosphatase, and elevated PTH. Another finding that can be used in the evaluation is elevated urinary cAMP. Treatment of primary hyperparathyroidism is usually surgical.

Educational Objective: Urinary cAMP is elevated in patients with primary hyperparathyroidism.
References: Marcocci C, Cetani F. Clinical practice. Primary hyperparathyroidism. N Engl J Med. 2011;365(25):2389-97.
Broadus AE. Nephrogenous Cyclic AMP as a Parathyroid Function Test. Nephron. 1979;23(2-3):136-141.]]

Approved Approved::Yes
Keyword WBRKeyword::Urinary cAMP, WBRKeyword::Primary hyperparathyroidism, WBRKeyword::Hyperparathyroidism, WBRKeyword::Parathyroid, WBRKeyword::Hypercalcemia
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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