system
Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
A 46-year-old woman comes to the physician for a routine health examination. She was last seen by a physician 3 years ago. She has been healthy aside from occasional mild flank pain. Her only medication is a multivitamin. Her blood pressure is 154/90 mm Hg. Physical examination shows no abnormalities. Serum studies show:
Sodium 141 mEq/L
Potassium 3.7 mEq/L
Calcium 11.3 mg/dL
Phosphorus 2.3 mg/dL
Urea nitrogen 15 mg/dL
Creatinine 0.9 mg/dL
Albumin 3.6 g/dL
Subsequent serum studies show a repeat calcium of 11.2 mg/dL, parathyroid hormone concentration of 890 pg/mL, and 25-hydroxyvitamin D of 48 ng/mL (N = 25–80). Her 24-hour urine calcium excretion is elevated. An abdominal ultrasound shows several small calculi in bilateral kidneys. Further testing shows normal bone mineral density. Which of the following is the most appropriate next step in management?"
assistant
Refer to surgery for parathyroidectomy