A 50-year-old woman has serum calcium 11.8 mg/dL, phosphate 2.1 mg/dL, PTH 145 pg/mL (normal 10–65), and 24-hour urine calcium 420 mg/day. Dual-energy X-ray absorptiometry (DEXA) shows T-score of −2.7 at the distal radius. She is asymptomatic. What is the most appropriate management?
- A Parathyroidectomy ✓
- B Bisphosphonate therapy and surveillance
- C Cinacalcet to normalize calcium
- D Increased fluid intake and dietary calcium restriction
Correct answer: A. Parathyroidectomy
Explanation
This patient has asymptomatic primary hyperparathyroidism meeting surgical criteria: T-score ≤ −2.5 at any site (distal radius T-score −2.7 qualifies), urinary calcium >400 mg/day, and serum calcium >1 mg/dL above upper limit of normal. Current guidelines recommend parathyroidectomy for asymptomatic PHPT when any one of the surgical criteria is met. Bisphosphonates address bone density but do not cure the condition. Cinacalcet is reserved for patients who cannot undergo surgery.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.