A patient with primary hyperparathyroidism has serum calcium 11.4 mg/dL, PTH 145 pg/mL, eGFR 52 mL/min/1.73m², T-score −2.6 at lumbar spine, and one episode of nephrolithiasis. Which of the following correctly represents a criterion for surgical intervention (parathyroidectomy) per current guidelines?
- A Symptomatic nephrolithiasis in any patient regardless of age ✓
- B Serum calcium >1.0 mg/dL above upper limit of normal only
- C T-score worse than −2.0 at any site in postmenopausal women only
- D Age over 60 years alone
Correct answer: A. Symptomatic nephrolithiasis in any patient regardless of age
Explanation
Per the 2022 international guidelines on asymptomatic primary hyperparathyroidism, symptomatic nephrolithiasis (clinically apparent stone disease, nephrocalcinosis) is an absolute indication for parathyroidectomy regardless of age. Serum calcium criterion is >1 mg/dL above the upper limit of normal. T-score worse than −2.5 (not −2.0) at any skeletal site, age under 50 (not over 60), and eGFR <60 are additional criteria. Age over 60 alone is not an indication.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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