A 30-year-old woman is found to have a serum calcium of 11.4 mg/dL and PTH of 92 pg/mL (normal 15–65). She is asymptomatic. PTH-rP is undetectable. Her bone density Z-score is −1.8 at the hip. According to current guidelines (AAA 2022 consensus), which criterion mandates surgical parathyroidectomy?
- A Serum calcium 1 mg/dL above the upper limit of normal
- B Creatinine clearance < 60 mL/min
- C Age under 50 years ✓
- D T-score < −2.5 at any site or Z-score < −2.5 in premenopausal women
Correct answer: C. Age under 50 years
Explanation
Current guidelines for asymptomatic primary hyperparathyroidism recommend parathyroidectomy if any of the following are present: serum calcium >1 mg/dL above upper normal, age <50, eGFR <60 mL/min, T-score < −2.5 at lumbar spine/hip/distal radius, fragility fracture, 24-h urine calcium >400 mg/day, or nephrolithiasis. This patient's age of 30 (<50 years) alone meets the surgical criterion. A Z-score threshold (not T-score) applies specifically to premenopausal women/men under 50.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.