Calcium 10.6, then 10.2 ( 1 wk apart), vitamin d 15, pth 67, rt upper abd pain, rt flank pain, fatigue, primary or secondary hyperparathyroidism?

Both primary and sec: patient likely has combination of primary and secondary hyperparathyroidism.calcium level is high 10.6, intact PTH is not suppressed. This would indicate possible underlying primary hyperparathyroidism. While vitamin D deficiency can cause secondary hyperparathyroidism, usually calcium levels are not elevated in this context. recommend repeat evaluation after vitamin D replacement