Hyperparathyroidism Quiz: Ace Your Exams

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A 65-year-old woman with chronic kidney disease and type 2 diabetes mellitus presents to the clinic due to persistent fatigue. The patient mentions occasional bone pain and muscle weakness which she initially attributed to aging. She has attempted to stay active and has been trying to maintain a diet rich in calcium due to a family history of osteoporosis. On physical examination, the patient appears well-nourished with no significant abnormal findings. Laboratory studies are listed below. What is the most likely direct cause of this patient’s current condition?  

Laboratory study
Result
Serum calcium
8.1 mg/dL  
Serum phosphate  
5.2 mg/dL  
Glomerular filtration rate (GFR)  
19 mL/min/1.73 m2  
Parathyroid hormone (PTH)  
168 pg/mL  

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