TOPIC: RANDOM MIX
Which of the following pathophysiological mechanisms is the primary initial driver of secondary hyperparathyroidism in a patient with end-stage renal disease (renal osteodystrophy)?
A
Decreased renal excretion of calcium leading to transient hypercalcemia
B
Autonomous hypersecretion of parathyroid hormone from a parathyroid adenoma
C
Increased synthesis of 1,25-dihydroxyvitamin D3 by the failing kidneys
D
Phosphate retention causing hyperphosphatemia, which directly stimulates PTH release and suppresses 1-alpha-hydroxylase