According to current guidelines, which single finding in an otherwise asymptomatic 42-year-old man with biochemically confirmed primary hyperparathyroidism is by itself an indication for parathyroidectomy?
- A Serum calcium 0.3 mg/dL above the upper limit of normal
- B 24-hour urinary calcium excretion of 250 mg/day
- C Bone mineral density T-score of minus 2.6 at the lumbar spine ✓
- D Serum creatinine of 1.0 mg/dL with estimated GFR above 90 mL/min
Correct answer: C. Bone mineral density T-score of minus 2.6 at the lumbar spine
Explanation
Guidelines list any one of age under 50 years, serum calcium more than 1 mg/dL above the upper limit, a T-score of minus 2.5 or lower at any site, vertebral fracture, creatinine clearance below 60 mL/min, nephrolithiasis or nephrocalcinosis, or marked hypercalciuria above 400 mg/day as surgical indications. A T-score of minus 2.6 meets osteoporosis criteria. The calcium elevation here is too small, urinary calcium of 250 mg is below threshold, and renal function is normal.
Reference: Williams Textbook of Endocrinology, 13th ed.
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