Asymptomatic Primary Hyperparathyroidism

A 60-year-old woman is noted incidentally to have a calcium level of 10.8 mg per deciliter (normal range, 8.4 to 10.2 mg per deciliter). The parathyroid hormone level is 84 pg per milliliter (normal range, 10 to 65). She has never had a kidney stone or a fracture, and she feels well. Her urinary calcium excretion is normal. Her bone density is within 0.5 SD of the peak bone mass at the lumbar spine and the hip and is 1.0 SD below the peak bone mass at the forearm. How should her case be managed?