A 67-year-old man is evaluated for a recent diagnosis of primary hyperparathyroidism after an elevated serum calcium level was incidentally detected on laboratory testing. Medical history is significant only for hypertension, and his only medication is Ramipril. Physical examination: Temperature: 35.8 °C (96.4 °F) Blood pressure: 120/68 mm Hg Pulse rate: 62/min Respiration rate: 14/min BMI: 32.
The remainder of his examination is unremarkable. Laboratory studies: Creatinine 0.9 mg/dL (79.6 µmol/L) Parathyroid hormone: 98 pg/mL (98 ng/L) 25-hydroxyvitamin D: 19 ng/mL (47.4 nmol/L) Estimated glomerular filtration rate >60 mL/min/1.73 m 2 Dual-energy X-ray absorptiometry (DEXA) scan shows T-scores of –1.3 in the right femoral neck, –1.0 in the lumbar spine, and –1.4 in the non-dominant forearm. Fracture Risk Assessment Tool (FRAX) score indicates a 13% risk of major osteoporotic fracture…
