]> 2026-07-31T09:39:48+00:00 WBR0268 0 en Thiazide diuretics Loop diuretics Routine neck and serum chemistry surveillance '''Incorrect'''-Routine neck and serum chemistry surveillance is appropriate only in patients with asymptomatic primary hyperparathyroidism without any of the above-mentioned features. Bisphosphonate therapy '''Correct'''-Surgical exploration of the neck '''Correct'''-The patient is presenting with asymptomatic primary hyperparathyroidism. The laboratory diagnosis of hypercalcemia, hypophosphatemia and elevated serum PTH hormones, suggest primary hyperparathyroidism. Asymptomatic primary hyperparathyroidism is a common disorder particularly in females above 60 years of age who are usually diagnosed during a routine chemistry screening. While patients with symptomatic primary hyperparathyroidism require surgical intervention, not all patients with asymptomatic primary hyperparathyroidism except those with at least one of the following features would require a surgical intervention.<br> <br> 1.Age less than 50 years<br> 2.Serum calcium at least 1 mg/dL above the upper limit of normal<br> 3.Bone mineral density (BMD) lower than T-2.5 at lumbar spine, femoral neck, total hip, or 33% (one third) radius<br> <br> This patient has two of the above features i.e. serum calcium 1 mg/dL above the upper limit of normal and DEXA scan showing BMD lower than T-2.5 at lumbar spine and femoral neck. Thus surgical intervention is indicated in this patient. Community Medical Health Center Primary Care Office Inpatient Facilities Vendhan Ramanujam A 60 year old asymptomatic white female comes to the physicians office for a routine physical examination. Her routine lab test shows<br> <br> Sodium: 138 mEq/L<br> Potassium: 3.8 mEq/L<br> Bicarbonate: 26 mEq/L<br> Chloride: 101 mEq/L<br> Calcium: 12 mg/dL<br> Albumin: 4.0 g/dL<br> Phosphorus: 2.2 mg/dL<br> <br> PTH level is increased. Bone mineral density by dual energy X-ray absorptiometry (DEXA) shows T-2.5 bone mineral density 5 at lumbar spine and femoral neck. Neck examination reveals no mass. What is the most appropriate step in management of this patient? E Endocrine Electrolytes 2020-10-28T00:00:41Z 2459150.5004745 WBR0268