Medical Q&A : find your quiz answers here !

Which of the following is the first-line treatment for primary hyperparathyroidism?

A. Bisphosphonates
B. Calcimimetics
C. Parathyroidectomy
D. Vitamin D supplementation

The first-line treatment for primary hyperparathyroidism is:

C. Parathyroidectomy

Explanation:
Primary hyperparathyroidism is a condition characterized by excessive secretion of parathyroid hormone (PTH) due to one or more hyperfunctioning parathyroid glands. The definitive treatment is parathyroidectomy, especially in patients who meet surgical criteria or are symptomatic.

Key Points:

1. Indications for Parathyroidectomy:
   
   • Symptomatic hypercalcemia.
   • Osteoporosis or fractures.
   • Kidney stones (nephrolithiasis).
   • Hypercalciuria with reduced kidney function.
   • Age <50 years or serum calcium >1 mg/dL above the upper normal limit.
2. Other Treatments:
   
   • Bisphosphonates: Used to manage bone loss but do not address the underlying problem.
   • Calcimimetics (e.g., cinacalcet): Effective in reducing calcium levels in patients who cannot undergo surgery, particularly in secondary hyperparathyroidism or parathyroid carcinoma.
   • Vitamin D supplementation: Useful for concurrent vitamin D deficiency but not as a primary treatment for hyperparathyroidism.

Parathyroidectomy remains the gold standard for definitive management in appropriate candidates.