Primary Hyperparathyroidism — RACP Adult Medicine MCQ
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Correct answer: C — Refer for parathyroidectomy and let the surgical team plan further localisation
Explanation lettering: E = shown as A · A = shown as C · C = shown as D · D = shown as E
A is correct because renal impairment and nephrolithiasis are surgical indications; imaging localises operative anatomy but neither establishes nor excludes the biochemical diagnosis. B offers biochemical control but is not the curative strategy for an operable patient with complications. C reverses the correct diagnostic sequence. D ignores two independent surgical indications. E delays definitive care and adds low-yield radiation. An experienced parathyroid surgeon can plan bilateral exploration or additional imaging when first-line studies are discordant.
Reference: Endocrine Society of Australia, hyperparathyroidism guidance: https://www.endocrinesociety.org.au/guidelines.asp; Endocrine Society, Primary hyperparathyroidism guideline: https://www.endocrine.org/clinical-practice-guidelines/primary-hyperparathyroidism