Although most recommend surgery for asymptomatic 1° HHPTH, when is it considered mandatory?
“ROACH”
- Renal insufficiency (CR ↓ by 30%)
- Osteoporosis (T score < −2.5)
- Age <50
- Calcium >1 mg/dL above upper limit of normal
- Hypercalciuria (>400 mg/day Ca2+ excretion)