Would you refer a patient for parathyroidectomy if they have normal calcium levels, mild hyperparathyroidism, and evidence of osteopenia?  

It is important to be certain the patient has primary hyperparathyroidism by demonstrating by ultrasound or sestamibi scan the presence of an adenoma. Often patients with an elevated PTH and a normal calcium are also vitamin D deficient and have parathyroid hyperplasia. It is also important to rule ...

In such cases of normocalcemic hyperparathyroidism, I always order 24 hour urine for Calcium.