Surgery for primary hyperparathyroidism should be considered if certain indications are present.


Causes of primary hyperparathyroidism:

(1) parathyroid adenoma (usually single)

(2) primary parathyroid hyperplasia

(3) parathyroid carcinoma (rare)


Indications for parathyroidectomy:

(1) clinically symptomatic hypercalcemia

(2) past history of an episode of life-threatening hypercalcemia

(3) asymptomatic with one or more risk factors

(4) parathyroid carcinoma


Risk factors for asymptomatic primary hyperparathyroidism:

(1) age < 50 years

(2) elevated serum calcium (> 11.4 mg/dL; >= 1.0 mg/dL above upper limit of normal reference range)

(3) reduced creatinine clearance (< 70% of reference population)

(4) nephrolithiasis

(5) increased 24 hour urinary calcium excretion (> 400 mg per day)

(6) severe reduction in bone mass (T score < -2.5 at any site)

(7) inability to provide medical surveillance (impossible or undesirable)


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