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)
