Should I refer my patient for a parathyroidectomy?

Serum calcium > 1.0 mg/dL (0.25 mmol/L) above the upper limit of normal

Bone mineral density by dual-energy x-ray absorptiometry: T-score ≤ −2.5 at lumbar spine, total hip, femoral neck, or distal one-third radius

Vertebral fracture by radiography, computed tomography, or magnetic resonance imaging

Estimated glomerular filtration rate or creatinine clearance < 60 mL/minute

24-hour urine calcium level > 250 mg in women and > 300 mg in men

Presence of nephrolithiasis or nephrocalcinosis by radiography, ultrasonography, or computed tomography

Age < 50