Table 2.

Indications for surgery for the treatment of primary hyperparathyroidism.

1) Age <50 years.

2) Serum calcium > 1 mg/dL or >0.25 mmol/L of the upper limit of the reference interval for total calcium and >0.12 mmol/L for Ca2+.

3) BMD T-score ≤−2.5 at the lumbar spine, femoral neck, the total hip, or the 1/3 radius for postmenopausal women or males >50 yrs. A prevalent low-energy fracture (i.e., in the spine) is also considered an indication for surgery, which requires a routine X-ray of the thoracic and lumbar spine (or vertebral fracture assessment by DXA).

4) A glomerular filtration rate (GFR) of <60 ml/min. Further evaluation of asymptomatic patients with renal imaging (X-ray, CT or ultrasound) in order to detect silent kidney stones or nephrocalcinosis is advised [2]. A complete urinary stone risk profile should be performed in those individuals whose urinary calcium excretion is > 400 mg/day. If stone(s), nephrocalcinosis, or high stone risk is determined, surgery should be recommended.