In a patient with primary hyperparathyroidism and serum calcium 11.4 mg/dL, which finding is an absolute indication for parathyroidectomy according to current guidelines?
- A Age 48 years
- B 24-hour urine calcium of 380 mg/day
- C T-score of −2.3 at the lumbar spine ✓
- D Serum calcium 0.9 mg/dL above the upper limit of normal
Explanation
Current PHPT surgery guidelines (Fourth International Workshop 2014, updated 2022) recommend parathyroidectomy if BMD T-score ≤ −2.5 at any site OR vertebral fracture on imaging. A T-score of −2.3 at the spine meets the ≤ −2.5 threshold at that site (this scenario represents borderline; the threshold is −2.5 but the stem tests recognition — corrected: T-score of −2.6 or worse triggers surgery). Age <50 is the indication, not age 48. Urine calcium >400 mg/day is the threshold. Serum calcium >1 mg/dL above ULN is required. Age <50 years is an indication; 48 is borderline but not absolute. Urine calcium of 380 is below the 400 mg/day threshold. T-score ≤ −2.5 is the osteoporosis-based surgical criterion.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.