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Primary hyperparathyroidism — RCPSC IM MCQ

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HardEndocrinologyPrimary hyperparathyroidismRCPSC IM

A patient with primary hyperparathyroidism has recurrent kidney stones, osteoporosis and calcium 2.84 mmol/L. What is the best definitive management?

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Correct answer: B — Refer for parathyroidectomy after localization for operative planning

The best answer is “Refer for parathyroidectomy after localization for operative planning”. Symptomatic primary hyperparathyroidism with nephrolithiasis and skeletal disease is an indication for parathyroidectomy. Imaging localizes glands after biochemical diagnosis; medical measures do not provide equivalent definitive treatment when surgery is suitable. Severe hypercalcemia is treated concurrently when necessary, but stabilization does not replace definitive removal of the autonomous gland in a surgical candidate.

Reference: Osteoporosis Canada, 2023 clinical practice guideline executive summary: https://osteoporosis.ca/executive-summary-clinical-practice-guideline/