Primary hyperparathyroidism when to remove the parathyroids?

[medInUSA]

When is the answer to a question about primary hyperparathyrodism removal of the parathyroid glands???

according to Fischer master the boards step 3 page 89
- any symptomatic disease(stones bones groans moans)
- renal insufficiency
- markedly elevated 24 hour urine calcium
- very elevated serum calcium >12.5


But I just came upon a Uworld question which said
- reserved for those patients less than 50 years old
- worsening renal function
- osteoporosis
- serum calcium greater than 1 mg/dL over the upper limit of normal (upper limit is 10.2 so they are saying anyone >11.2)

so what does the serum calcium have to be > 11.2 or greater than 12.5 ?????

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[medInUSA]

Just found the answer in Harrison's

indications for removal in asymtpomatic pts:

serum calcium> 1 mg/dL above normal
urinary excreation in 24 hours >400 mg
creatinine clearance reduced by 30%
bone mineral density T score < -2.5 at any site
age <50