A 55-year-old woman has a serum calcium of 2.82 mmol/L, PTH of 95 pg/mL (normal 15–65), 24-hour urine calcium of 2.8 mmol, and DEXA showing osteoporosis (T-score –2.7 at hip). She is asymptomatic. According to current guidelines, the next step is:
- A Observation with annual monitoring
- B Cinacalcet therapy
- C Parathyroidectomy ✓
- D Bisphosphonate therapy
Correct answer: C. Parathyroidectomy
Explanation
According to the Fourth International Workshop on PHPT guidelines (2014, updated), asymptomatic primary hyperparathyroidism meets surgical criteria when any one of the following is present: serum calcium >0.25 mmol/L above upper normal, T-score ≤ –2.5 at any site, age <50, 24-hour urine calcium >400 mg/day with elevated stone risk, or creatinine clearance <60 mL/min. This patient's T-score of –2.7 qualifies for parathyroidectomy.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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