A 45-year-old woman has serum calcium 11.8 mg/dL, PTH 95 pg/mL (normal 10–65), phosphate 2.1 mg/dL, and 24-hour urine calcium 420 mg. She is asymptomatic. According to current guidelines (2022 Fourth International Workshop), which criterion alone is sufficient to recommend parathyroidectomy?
- A Serum calcium > 1 mg/dL above upper normal limit
- B T-score ≤ −2.5 at any site or vertebral fracture on imaging ✓
- C 24-hour urine calcium > 400 mg/day
- D Patient age < 50 years
Explanation
The 2022 Fourth International Workshop on PHPT recommends surgery if any one criterion is met: serum calcium >1 mg/dL above ULN, GFR <60 mL/min, T-score ≤−2.5 at spine/hip/radius or vertebral fracture detected on imaging (DXA or X-ray), 24-hour urine calcium >400 mg/day with elevated stone risk, or age <50 years. A T-score ≤−2.5 at any measured site (including DXA vertebral fracture assessment) is independently sufficient. The 24-hour urine calcium criterion alone requires concomitant elevated stone risk assessment; age <50 is also a criterion, but option B (bone criteria) is directly stated as a stand-alone surgical indication.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.