Primary Hyperparathyroidism Surgery Criteria (AACE/AAES)

Patient Age (Years)

Serum Calcium (mg/dL)

Lowest T-score (DXA)

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

Evaluating patients with biochemically confirmed Primary Hyperparathyroidsm (PHPT).

Determining if an "asymptomatic" patient should proceed to parathyroidectomy.

Adhering to the Fifth International Workshop guidelines on Asymptomatic PHPT.

How it Works

Biochemical / Age Thresholds

Parameter	Threshold for Surgery
Serum Calcium	> 1.0 mg/dL above ULN (> 2.8 mmol/L)
Age	< 50 years
T-score (DXA)	≤ -2.5 (Spine, Hip, or Distal Radius)
Vertebral Fracture	Presence of fracture on XR, CT, MRI, or VFA

Renal Criteria

Creatinine Clearance / eGFR < 60 mL/min.

24-hour urine calcium > 400 mg/day (or ethnicity-adjusted high).

Presence of Nephrolithiasis or Nephrocalcinosis on imaging.

Last Comprehensive Review: 2026

Recent Journal Updates

BJOGJul 22, 2026

Care of the Newborn and Cord During the Third Stage of Labour (Scientific Impact Paper No. 78)

Clinical Context

We think this has broad domain relevance to Asymptomatic PHPT Surgery Criteria.

JAMAJul 21, 2026

Correction to Primary Composite Outcome in a Trial of Transfusion Strategy

Clinical Context

We think this might be relevant to the clinical guidance for Asymptomatic PHPT Surgery Criteria.

JAMAJul 21, 2026

Earlier Egg Introduction Recommendations Linked to Fewer Infant Allergies

Clinical Context

We think this has broad domain relevance to Asymptomatic PHPT Surgery Criteria.

Primary Hyperparathyroidism Surgery Criteria (AACE/AAES)

When to Use

When to Use

How it Works

Biochemical / Age Thresholds

Renal Criteria

Clinical Pearls

Distal Radius Importance

Silent Stones

The Evidence

Primary Source

Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism: Summary Statement from the Fifth International Workshop.

Recent Journal Updates

Primary Hyperparathyroidism Surgery Criteria (AACE/AAES)

When to Use

When to Use

How it Works

Biochemical / Age Thresholds

Renal Criteria

Clinical Pearls

Distal Radius Importance

Silent Stones

The Evidence

Primary Source

Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism: Summary Statement from the Fifth International Workshop.

Recent Journal Updates