<prompt> Primary hyperparathyroidism is suggested by all of the following, except:Increased serum calciumLow urinary calciumIncreased PTHIncreased C-AMP  <response>: Answer is B Low Urinary Calcium: Primary Hyperparathyroidism is associated with normal or increased urinary calcium levels. Increased PTH and Increased Serum calcium in association with high levels of urinary calcium suggest a diagnosis of Primary Hyperparathyroidism Increased PTH and Increased Serum calcium in association with low levels of urinary calcium suggest a diagnosis of Familial Hvpocalciuric Hvpercalcemia FHH Disorder S-Ca2- S-PHOS Intact PTH PTHrP Urine Calcium Urinary Ca2 Creatinine Clearance ratio Primary HPTH 1 sl, or N 1 or N ,I, U-Ca2 100mg24h 0.02 Familial benign hypercalcemia l .Ior N 1 or N ,I, U-Ca2 100mg24h 0.01 This clearance ratio is calculated from simultaneous fasting serum and urine Ca and creatinine measurements. The urine sample can be from a spot or a 24 h collection. The clearance ratio is calculated as follows: Urine Ca mg24hx plasma creatinine mgdl plasma Ca mgdL x urine creatinine mg24h 