A 40-year-old woman presents with symptomatic hypercalcaemia (serum calcium 3.1 mmol/L, corrected). PTH is 98 pg/mL (elevated). 24-hour urinary calcium is 620 mg/day. The most appropriate definitive management is:
- A Oral cinacalcet (calcimimetic)
- B High fluid intake and loop diuretics
- C Parathyroidectomy ✓
- D Bisphosphonate infusion
Correct answer: C. Parathyroidectomy
Explanation
Symptomatic primary hyperparathyroidism (calcium >3.0 mmol/L, high urinary calcium, elevated PTH) meets surgical criteria for parathyroidectomy, which is the only curative treatment. Cinacalcet reduces calcium but is used in inoperable cases or secondary/tertiary hyperparathyroidism in CKD. Bisphosphonates address bone loss but do not treat the primary disorder. Hydration provides temporary symptomatic relief.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.