A known patient with renal stone disease developed pathological fracture along with abdominal pain and certain psychiatric symptoms. He should be investigated for
**Core Concept**
Pathological fractures, psychiatric symptoms, and abdominal pain in a patient with renal stone disease suggest an underlying metabolic disorder, possibly hyperparathyroidism, which can lead to bone resorption, renal calcification, and neuropsychiatric manifestations.
**Why the Correct Answer is Right**
The patient's presentation is consistent with hyperparathyroidism, a condition characterized by excessive parathyroid hormone (PTH) production. Elevated PTH levels lead to increased calcium levels in the blood (hypercalcemia), which can cause renal stone formation, bone resorption, and neuropsychiatric symptoms such as depression, anxiety, and psychosis. The parathyroid glands are located near the thyroid gland in the neck and regulate calcium levels in the blood by secreting PTH.
**Why Each Wrong Option is Incorrect**
**Option A:** Although osteoporosis can cause pathological fractures, it does not explain the abdominal pain or psychiatric symptoms in this context.
**Option B:** Chronic kidney disease can cause renal stone disease, but it does not typically cause pathological fractures or psychiatric symptoms.
**Option C:** Gastrointestinal disorders can cause abdominal pain, but they do not explain the pathological fractures or psychiatric symptoms in this patient.
**Clinical Pearl / High-Yield Fact**
Remember that hyperparathyroidism can present with a triad of symptoms: renal stone disease, bone disease (including pathological fractures), and neuropsychiatric manifestations.
**Correct Answer:** D. Hyperparathyroidism.