Correct!
4. 1 and 3
The low normal parathyroid hormone level would seem to exclude primary hyperparathyroidism in which a tumor of the parathyroid gland produces excessive amount of parathyroid hormone (3). However, both the 1,25-dihydroxy vitamin D3 and parathyroid hormone-related protein are elevated or at the upper limit of normal. The elevated alkaline phosphatase suggests either bone or liver lesions. However, her other liver enzymes were normal.
Which of the following should be performed next? (Click on the correct answer to proceed to the fifth of six panels)