A 45-year-old woman is incidentally found to have a serum calcium of 11.2 mg/dL on routine testing. PTH is 95 pg/mL (elevated). She is asymptomatic with eGFR of 68 mL/min/1.73m² and DEXA T-score of −1.8 at the lumbar spine. Which criterion for parathyroidectomy is met?

• A T-score worse than −2.5 at any site
• B eGFR < 60 mL/min/1.73 m²
• C Age under 50 years
• D Serum calcium >1 mg/dL above upper limit of normal ✓

Explanation

The 4th International Workshop on Asymptomatic Primary Hyperparathyroidism criteria for surgery include: serum calcium >1 mg/dL above upper limit of normal (ULN), eGFR <60, T-score ≤−2.5 at any site, age <50, urine calcium >400 mg/day with high stone risk, or presence of nephrolithiasis/nephrocalcinosis. This patient's calcium of 11.2 mg/dL is >1 mg/dL above the ULN of 10.2 mg/dL, meeting criteria. Her T-score of −1.8 does not meet the −2.5 threshold and eGFR >60 does not qualify.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.