A 50-year-old man with asymptomatic primary hyperparathyroidism is under observation. Which of the following is an indication for surgical intervention per international guidelines?
- A Serum calcium >1 mg/dL above the upper limit of normal, eGFR <60 mL/min, or T-score < -2.5 ✓
- B Serum calcium 10.5 mg/dL with no symptoms
- C Age >50 years alone
- D Elevated PTH alone without hypercalcaemia
Correct answer: A. Serum calcium >1 mg/dL above the upper limit of normal, eGFR <60 mL/min, or T-score < -2.5
Explanation
Per the 4th International Workshop on Asymptomatic Primary Hyperparathyroidism (2014, updated guidelines), surgical indications include: serum calcium >1 mg/dL above upper limit of normal; eGFR <60 mL/min; osteoporosis (T-score <−2.5 at any site or previous fragility fracture); age <50 years (not >50); or 24-hour urinary calcium >400 mg/day with increased stone risk. Age <50 years (not >50) is itself an indication due to long exposure risk. This patient at age 50 with mild hypercalcaemia needs individual assessment based on these criteria.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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