A 45-year-old man has hypercalcemia (Ca²⁺ 3.1 mmol/L), nephrolithiasis, and an incidental fracture. PTH is 12× the upper limit of normal. The MOST appropriate definitive management is:
- A Bisphosphonate therapy with zoledronic acid
- B Parathyroidectomy ✓
- C Cinacalcet (calcimimetic)
- D Low-calcium diet and high fluid intake
Correct answer: B. Parathyroidectomy
Explanation
This presentation (symptomatic hypercalcemia, nephrolithiasis, fracture, markedly elevated PTH) meets the classic indications for parathyroidectomy in primary hyperparathyroidism. Cinacalcet reduces calcium but does not cure the disease and is reserved for patients unfit for surgery. Bisphosphonates improve bone density but do not correct hypercalcemia in primary PHPT. Dietary restriction alone is insufficient for symptomatic disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.