SECONDARY HYPERPARATHYROIDISM, AND KIDNEY STONES

SECONDARY HYPERPARATHYROIDISM,  AND KIDNEY STONES.     10/10/2016
QUESTION--i  need some advise pls .   have 33 yr old woman- seen with abdo pain and ct kub showed many renal stones   also mixed density adnexal mass.
bloods c. ca sl low,      alk phos 300 high        PTH 95 high   vit d 11 low
looks like secondary hyperparathyroidism  but i was always under impression   stones in primary.
how does the stones formed in this scenario  pls any good places to read  up on physio/pathology re this thank you Kum UK   cnd9@yahoo.com.
RESPONSE--This is a quite unusual patient who appears to have secondary hyperparathyroidism due to vitamin deficiency.  The elevated alkaline phosphatase suggests osteomalacia may be present.  It would be unusual to have kidney stones in this setting.  It would be helpful if a stone could be analyzed after lithotripsy.  A 24 hour urine for calcium, oxalate, citrate, uric acid and creatinine would be helpful in the differential diagnosis.  I don't know now of any publications which could explain the features of this case.   Frederick R. Singer