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2nd May 2024
A 60-year-old woman presents with recurrent kidney stones and fatigue for the past year.
A 60-year-old woman presents with recurrent kidney stones and fatigue for the past year. She also reports a recent history of bone pain and constipation. Her medical history is significant for hypertension, which is currently managed with a thiazide diuretic. On examination, she appears lethargic and dehydrated.
Investigations:
Serum Calcium: 2.75 mmol/L (2.2–2.6)
Serum Phosphate: 0.8 mmol/L (0.8–1.5)
Serum Creatinine: 90 µmol/L (45–84)
Serum PTH: Elevated
24-hour urinary calcium: 450 mg/day
Bone mineral density (BMD) T-score: -2.6 at the lumbar spine
Which is the most appropriate initial treatment?
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