Calcium and Parathyroid USMLE Step 1 Practice Question
A 41-year-old man with MEN1 presents for evaluation of primary hyperparathyroidism. Vital signs are normal (BP 128/82, HR 72, RR 14, Temp 37°C). Laboratory studies show ionized calcium 5.8 mg/dL, PTH 156 pg/mL, and phosphate 2.3 mg/dL. Serum creatinine is 0.9 mg/dL. Dual-energy x-ray absorptiometry shows normal bone mineral density. He denies nephrolithiasis, cognitive changes, or polyuria. Which of the following is the most appropriate management recommendation?
Answer choices
- AObservation with serial monitoring of serum calcium and PTH annually
- BSingle parathyroid adenoma removal after preoperative localization
- CMedical management with cinacalcet as long-term definitive therapy
- DVitamin D and calcium supplementation to prevent osteoporosis
- EBilateral subtotal parathyroidectomy or total parathyroidectomy with autotransplantation due to high recurrence risk in MEN1Correct answer
- FMinimally invasive single-gland parathyroidectomy appropriate for sporadic disease but contraindicated in MEN1 multiglandular hyperplasia
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