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Hypercalcaemia — MRCP Part 1 MCQ

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HardEndocrinology & DiabetesHypercalcaemiaMRCP Part 1

A patient has repeatedly raised albumin-adjusted calcium with an inappropriately high parathyroid hormone concentration. Before deciding on parathyroid surgery, which principle is correct?

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Correct answer: C — Base the surgery decision on biochemical and end-organ criteria

The best answer is “Base the surgery decision on biochemical and end-organ criteria”. Primary hyperparathyroidism is a biochemical diagnosis. Symptoms, calcium level and renal or skeletal end-organ involvement determine specialist referral and surgery; localisation imaging is performed only after a surgery decision to plan the approach. Negative ultrasound or sestamibi imaging does not negate the diagnosis or preclude expert exploration.

Reference: NICE NG132, Primary hyperparathyroidism: https://www.nice.org.uk/guidance/ng132/chapter/Recommendations