INDICATIONS FOR SURGERY (National Institutes of Health Consensus Statement)

1) Symptomatic patients should have surgery. This means anyone who has kidney stones, calcium deposits in the kidneys, or people with large areas of bone breakdown.

2) Asymptomatic patients should have surgery if they meet at least one of the criteria below:

a. Serum calcium level >1.0 mg per dL (0.25 mmol per L) above the upper limit of normal
b. Urinary calcium excretion >400 mg per 24 hours (10 mmol per day)
c. Creatinine clearance reduced by more than 30 percent
d. Bone density (lumbar spine, hip, or forearm) that is >2.5 standard deviations below peak bone mass (T score –2.5)
e. Patient age f. Medical surveillance not desirable or possible
g. Surgery requested by patient

Can asymptomatic patients can be monitored if they do not wish to have surgery? Yes, under certain conditions:

a. Serum calcium level only mildly elevated
b. No previous episode of life-threatening hypercalcemia
c. Normal renal status (i.e., creatinine clearance of >70 percent without nephrolithiasis or nephrocalcinosis)
d. Normal bone status (i.e., T score above –2.5 at lumbar spine, hip, and forearm)