Top

Published in:

01-11-2021 | Hyperparathyroidism | Review

A practical approach to normocalcemic primary hyperparathyroidism

Authors: José Luis Muñoz de Nova, Miguel Sampedro-Nuñez, Isabel Huguet-Moreno, Mónica Marazuela Azpiroz

Published in: Endocrine | Issue 2/2021

Abstract

Normocalcemic primary hyperparathyroidism is an entity on which several issues about its clinical management remains unclear. This is reflected in the main current guidelines, where there are no evidence-based specific recommendations. Through an exhaustive review of current literature, a clinical management algorithm for these patients is proposed. We consider the diagnosis criteria, the differential diagnosis, the clinical manifestations, and the treatment indications. When indicated, we also review the preoperative locations techniques and the surgical approach. Finally, when surgical treatment is not indicated, the patient is not a candidate to surgery or refuse surgical management, we review the medical treatment options and the follow-up schemes.

J.P. Bilezikian, A.A. Khan, J.T. Potts, Guidelines for the management of asymptomatic primary hyperparathyroidism: Summary statement from the third international workshop. J. Clin. Endocrinol. Metab. 94, 335–339 (2009). https://doi.org/10.1210/jc.2008-1763CrossRefPubMedPubMedCentral

N.E. Cusano, S.J. Silverberg, J.P. Bilezikian, Normocalcemic primary hyperparathyroidism. J. Clin. Densitom. 16, 33–39 (2013). https://doi.org/10.1016/j.jocd.2012.12.001CrossRefPubMedPubMedCentral

J.P. Bilezikian, M.L. Brandi, R. Eastell, S.J. Silverberg, R. Udelsman, C. Marcocci, J.T. Potts, Guidelines for the management of asymptomatic primary hyperparathyroidism: Summary statement from the fourth international workshop. J. Clin. Endocrinol. Metab. 99, 3561–3569 (2014). https://doi.org/10.1210/jc.2014-1413CrossRefPubMedPubMedCentral

S.M. Wilhelm, T.S. Wang, D.T. Ruan, J.A. Lee, S.L. Asa, Q.Y. Duh, G.M. Doherty, M.F. Herrera, J.L. Pasieka, N.D. Perrier, S.J. Silverberg, C.C. Solórzano, C. Sturgeon, M.E. Tublin, R. Udelsman, S.E. Carty, The American association of endocrine surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 151, 959–968 (2016). https://doi.org/10.1001/jamasurg.2016.2310CrossRefPubMed

R. Eastell, M.L. Brandi, A.G. Costa, P. D’Amour, D.M. Shoback, R. Thakker, V: Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J. Clin. Endocrinol. Metab. 99, 3570–3579 (2014). https://doi.org/10.1210/jc.2014-1414CrossRefPubMed

M. Schini, R.M. Jacques, E. Oakes, N.F.A. Peel, J.S. Walsh, R. Eastell, Normocalcemic hyperparathyroidism: Study of its prevalence and natural history. J. Clin. Endocrinol. Metab. 105, E1171–E1186 (2020). https://doi.org/10.1210/clinem/dgaa084CrossRefPubMedCentral

J.F. Aloia, M. Feuerman, J.K. Yeh, Reference range for serum parathyroid hormone. Endocr. Pract. 12, 137–144 (2006). https://doi.org/10.4158/EP.12.2.137CrossRefPubMedPubMedCentral

C.-J.L. Farrell, L. Nguyen, A.C. Carter, Parathyroid hormone: data mining for age-related reference intervals in adults. Clin. Endocrinol. (Oxf.). 88, 311–317 (2018). https://doi.org/10.1111/cen.13486CrossRefPubMed

J.A. Delgado, J.M. Bauça, M.I. Pastor, A. Barceló, Use of data mining in the establishment of age-adjusted reference intervals for parathyroid hormone. Clin. Chim. Acta 508, 217–220 (2020). https://doi.org/10.1016/j.cca.2020.05.030CrossRefPubMed

10.

N.B. Dawood, K.L. Yan, A. Shieh, M.J. Livhits, M.W. Yeh, A.M. Leung, Normocalcaemic primary hyperparathyroidism: An update on diagnostic and management challenges. Clin. Endocrinol. (Oxf.). 93, 519–527 (2020). https://doi.org/10.1111/cen.14315CrossRefPubMed

11.

J. Gómez-Ramírez, A. Gómez-Valdazo, P. Luengo, B. Porrero, I. Osorio, S. Rivas, Comparative prospective study on the presentation of normocalcemic primary hyperparathyroidism. Is it more aggressive than the hypercalcemic form? Am. J. Surg. 219, 150–153 (2020). https://doi.org/10.1016/j.amjsurg.2019.10.032CrossRefPubMed

12.

L.M. Calvi, D.A. Bushinsky, When is it appropriate to order an ionized calcium? J. Am. Soc. Nephrol. 19, 1257–1260 (2008). https://doi.org/10.1681/ASN.2007121327CrossRefPubMed

13.

S. Corbetta, Normocalcemic Hyperparathyroidism. Front. Horm. Res. 51, 23–39 (2019). https://doi.org/10.1159/000491036CrossRefPubMed

14.

G. Zavatta, B.L. Clarke, Normocalcemic Hyperparathyroidism: A Heterogeneous Disorder Often Misdiagnosed? JBMR 4, e10391 (2020). https://doi.org/10.1002/jbm4.10391CrossRef

15.

A. Giustina, R. Bouillon, N. Binkley, C. Sempos, R.A. Adler, J. Bollerslev, B. Dawson-Hughes, P.R. Ebeling, D. Feldman, A. Heijboer, G. Jones, C.S. Kovacs, M. Lazaretti-Castro, P. Lips, C. Marcocci, S. Minisola, N. Napoli, R. Rizzoli, R. Scragg, J.H. White, A.M. Formenti, J.P. Bilezikian, C. Labrador, Controversies in Vitamin D: A Statement From the Third International Conference. JBMR . 4, e10417 (2020). https://doi.org/10.1002/jbm4.10417CrossRef

16.

C. Cipriani, J. Pepe, L. Colangelo, S. Minisola, Vitamin D and Secondary Hyperparathyroid States. Front. Horm. Res. 50, 138–148 (2018). https://doi.org/10.1159/000486077CrossRefPubMed

17.

A. Palermo, A.M. Naciu, G. Tabacco, S. Falcone, A. Santonati, D. Maggi, L.D.’ Onofrio, S.I. Briganti, D. Castellitto, A. Casini, C. Pedone, D. Lelli, A. Fabbri, J.P. Bilezikian, N. Napoli, P. Pozzilli, S. Manfrini, R. Cesareo, Clinical, biochemical, and radiological profile of normocalcemic primary hyperparathyroidism. J. Clin. Endocrinol. Metab. 105, 2609–2616 (2020). https://doi.org/10.1210/clinem/dgaa174CrossRef

18.

B.C. Silva, N.E. Cusano, J.P. Bilezikian, Primary hyperparathyroidism. Best Pract. Res. Clin. Endocrinol. Metab. 101247 (2018). https://doi.org/10.1016/j.beem.2018.09.013

19.

X. Wang, L. Meng, C. Su, S.A. Shapses, Low free (but not total) 25-hydroxyvitamin D levels in subjects with normocalcemic hyperparathyroidism. Endocr. Pract. 26, 174–178 (2020). https://doi.org/10.4158/EP-2019-0325CrossRefPubMed

20.

N.E. Cusano, C. Cipriani, J.P. Bilezikian, Management of normocalcemic primary hyperparathyroidism. Best. Pract. Res. Clin. Endocrinol. Metab. 32, 837–845 (2018). https://doi.org/10.1016/j.beem.2018.09.009CrossRefPubMed

21.

J. Gómez-Ramírez, R. Mihai, Normocalcaemic primary hyperparathyroidism: a diagnostic and therapeutic algorithm. Langenbeck’s Arch. Surg. 402, 1103–1108 (2017). https://doi.org/10.1007/s00423-017-1617-2CrossRef

22.

C. Eller-Vainicher, E. Cairoli, V.V. Zhukouskaya, V. Morelli, S. Palmieri, A. Scillitani, P. Beck-Peccoz, I. Chiodini, Prevalence of subclinical contributors to low bone mineral density and/or fragility fracture. Eur. J. Endocrinol. 169, 225–237 (2013). https://doi.org/10.1530/EJE-13-0102CrossRefPubMed

23.

G. Martínez Díaz-Guerra, E. Jódar Gimeno, R. Reyes García, J.M. Gómez Sáez, M. Muñoz-Torres, Normocalcemic primary hyperparathyroidism: recommendations for management and follow-up. Endocrinol. Nutr. 60, 456–.e1–6 (2013). https://doi.org/10.1016/j.endonu.2013.01.015

24.

B.H. Eisner, J. Ahn, M.L. Stoller, Differentiating primary from secondary hyperparathyroidism in stone patients: the “thiazide challenge”. J. Endourol. 23, 191–192 (2009). https://doi.org/10.1089/end.2008.0567CrossRefPubMed

25.

M.L. Griebeler, A.E. Kearns, E. Ryu, P. Thapa, M.A. Hathcock, L.J. Melton, R.A. Wermers, Thiazide-associated hypercalcemia: incidence and association with primary hyperparathyroidism over two decades. J. Clin. Endocrinol. Metab. 101, 1166–1173 (2016). https://doi.org/10.1210/jc.2015-3964CrossRefPubMedPubMedCentral

26.

G. Mantovani, M. Bastepe, Diagnosis and management of pseudohypoparathyroidism and related disorders: first international Consensus Statement. Nat. Rev. Endocrinol. 47, 41. https://doi.org/10.1038/s41574-018-0042-0

27.

D.A. Anastasilakis, P. Makras, S.A. Polyzos, A.D. Anastasilakis, Asymptomatic and normocalcemic hyperparathyroidism, the silent attack: a combo-endocrinology overview. Hormones 18, 65–70 (2019). https://doi.org/10.1007/s42000-018-0069-6CrossRefPubMed

28.

M.M. Tuna, M. Çalışkan, M. Ünal, T. Demirci, B.A. Doğan, K. Küçükler, M. Özbek, D. Berker, T. Delibaşı, S. Güler, Normocalcemic hyperparathyroidism is associated with complications similar to those of hypercalcemic hyperparathyroidism. J. Bone Miner. Metab. 34, 331–335 (2016). https://doi.org/10.1007/s00774-015-0673-3CrossRefPubMed

29.

E. Traini, R. Bellantone, S.E. Tempera, S. Russo, C. De Crea, C.P. Lombardi, M. Raffaelli, Is parathyroidectomy safe and effective in patients with normocalcemic primary hyperparathyroidism? Langenbeck’s Arch. Surg. 403, 317–323 (2018). https://doi.org/10.1007/s00423-018-1659-0CrossRef

30.

C. Berger, O. Almohareb, L. Langsetmo, D.A. Hanley, C.S. Kovacs, R.G. Josse, J.D. Adachi, J.C. Prior, T. Towheed, K.S. Davison, S.M. Kaiser, J.P. Brown, D. Goltzman, Characteristics of hyperparathyroid states in the Canadian multicentre osteoporosis study (CaMos) and relationship to skeletal markers. Clin. Endocrinol. (Oxf.). 82, 359–368 (2015). https://doi.org/10.1111/cen.12569CrossRefPubMed

31.

L. Rejnmark, H. Ejlsmark-Svensson, Effects of PTH and PTH hypersecretion on bone: a clinical perspective. Curr. Osteoporos. Rep. 18, 103–114 (2020). https://doi.org/10.1007/s11914-020-00574-7CrossRefPubMed

32.

A.M. Formenti, F. Tecilazich, R. Giubbini, A. Giustina, Risk of vertebral fractures in hypoparathyroidism. Rev. Endocr. Metab. Disord. 20, 295–302 (2019). https://doi.org/10.1007/s11154-019-09507-xCrossRefPubMed

33.

A.M. Naciu, G. Tabacco, S. Falcone, G.G. Incognito, I. Chiodini, D. Maggi, C. Pedone, D. Lelli, J.P. Bilezikian, N. Napoli, S. Manfrini, R. Cesareo, A. Palermo, Bone quality, as measured by trabecular bone score in normocalcaemic primary hyperparathyroidism. Endocr. Pract. (2021). https://doi.org/10.1016/j.eprac.2021.04.884

34.

G. Díaz-Soto, D. de Luis Román, O.I. Jauregui, L. Briongo, E. Romero, J.L. Pérez-Castrillón, Trabecular bone score in patients with normocalcemic hyperparathyroidism. Endocr. Pract. 22, 703–707 (2016). https://doi.org/10.4158/EP151055.ORCrossRefPubMed

35.

G.B. Cansu, N. Yilmaz, S. Özdem, M.K. Balci, G. Süleymanlar, C. Arici, A. Boz, R. Sari, H.A. Altunbaş, Parathyroidectomy in asymptomatic primary hyperparathyroidism reduces carotid intima-media thickness and arterial stiffness. Clin. Endocrinol. (Oxf.). 84, 39–47 (2016). https://doi.org/10.1111/cen.12952CrossRefPubMed

36.

A.J. van Ballegooijen, I. Reinders, M. Visser, I.A. Brouwer, Parathyroid hormone and cardiovascular disease events: a systematic review and meta-analysis of prospective studies. Am. Heart J. 165, 655–664 (2013). https://doi.org/10.1016/j.ahj.2013.02.014. 664.e1–5CrossRefPubMed

37.

G. Chen, Y. Xue, Q. Zhang, T. Xue, J. Yao, H. Huang, J. Liang, L. Li, W. Lin, L. Lin, L. Shi, L. Cai, J. Wen, Is normocalcemic primary hyperparathyroidism harmful or harmless? J. Clin. Endocrinol. Metab. 100, 2420–2424 (2015). https://doi.org/10.1210/jc.2014-4432CrossRefPubMed

38.

F.Y. Ozturk, S. Erol, M.M. Canat, S. Karatas, I. Kuzu, S.D. Cakir, Y. Altuntas, Patients with normocalcemic primary hyperparathyroidism may have similar metabolic profile as hypercalcemic patients. Endocr. J. 63, 111–118 (2016). https://doi.org/10.1507/endocrj.EJ15-0392CrossRef

39.

S. Beysel, M. Caliskan, M. Kizilgul, M. Apaydin, S. Kan, M. Ozbek, E. Cakal, Parathyroidectomy improves cardiovascular risk factors in normocalcemic and hypercalcemic primary hyperparathyroidism. BMC Cardiovasc. Disord. 19, 1–8 (2019). https://doi.org/10.1186/s12872-019-1093-4CrossRef

40.

O. Koubaity, D. Mandry, P.L. Nguyen-Thi, F. Bihain, C. Nomine-Criqui, L. Demarquet, V. Croise-Laurent, L. Brunaud, Coronary artery disease is more severe in patients with primary hyperparathyroidism. Surgery 167, 149–154 (2020). https://doi.org/10.1016/j.surg.2019.05.094CrossRefPubMed

41.

S. Temizkan, O. Kocak, K. Aydin, A. Ozderya, G. Arslan, N. Yucel, M. Sargin, Normocalcemic hyperparathyroidism and insulin resistance. Endocr. Pract. 21, 23–29 (2015). https://doi.org/10.4158/EP14195.ORCrossRefPubMed

42.

P.N. Mesquita, A.P.D.L. Leite, S. Crisóstomo, C. das, E.V. Filho, L. Da Cunha Xavier, F. Bandeira, Evaluation of coronary calcium score in patients with normocalcemic primary hyperparathyroidism. Vasc. Health Risk Manag 13, 225–229 (2017). https://doi.org/10.2147/VHRM.S128084CrossRefPubMedPubMedCentral

43.

L.S. Bislev, L. Langagergaard Rødbro, T. Sikjær, L. Rejnmark, Effects of elevated parathyroid hormone levels on muscle health, postural stability and quality of life in vitamin D-insufficient healthy women: a cross-sectional study. Calcif. Tissue Int. 105, 642–650 (2019). https://doi.org/10.1007/s00223-019-00612-2CrossRefPubMed

44.

L. Voss, M. Nóbrega, L. Bandeira, L. Griz, P.A.S. Rocha-Filho, F. Bandeira, Impaired physical function and evaluation of quality of life in normocalcemic and hypercalcemic primary hyperparathyroidism. Bone 141, 115583 (2020). https://doi.org/10.1016/j.bone.2020.115583CrossRefPubMed

45.

H. Lowe, D.J. McMahon, M.R. Rubin, J.P. Bilezikian, S.J. Silverberg, Normocalcemic primary hyperparathyroidism: Further characterization of a new clinical phenotype. J. Clin. Endocrinol. Metab. 92, 3001–3005 (2007). https://doi.org/10.1210/jc.2006-2802CrossRefPubMed

46.

H. Šiprová, Z. Fryšák, M. Souček, Primary hyperparathyroidism, with a focus on management of the normocalcemic form: to treat or not to treat? Endocr. Pract. 22, 294–301 (2016). https://doi.org/10.4158/EP15704.ORCrossRefPubMed

47.

H. Yan, N. Calcatera, T.A. Moo-Young, R.A. Prinz, D.J. Winchester, Degree of hypercalcemia correlates with parathyroidectomy but not with symptoms. Am. J. Surg. 217, 437–440 (2019). https://doi.org/10.1016/j.amjsurg.2018.09.010CrossRefPubMed

48.

J.Y. Lim, M.C. Herman, L. Bubis, I. Epelboym, J.D. Allendorf, J.A. Chabot, J.A. Lee, J.H. Kuo, Differences in single gland and multigland disease are seen in low biochemical profile primary hyperparathyroidism. Surgery 161, 70–77 (2017). https://doi.org/10.1016/j.surg.2016.08.054CrossRefPubMed

49.

G. Trinh, E. Rettig, S.I. Noureldine, J.O. Russell, N. Agrawal, A. Mathur, J.D. Prescott, M.A. Zeiger, R.P. Tufano, Surgical management of normocalcemic primary hyperparathyroidism and the impact of intraoperative parathyroid hormone testing on outcome. Otolaryngol. Head. Neck Surg. 159, 630–637 (2018). https://doi.org/10.1177/0194599818793879CrossRefPubMed

50.

A. Kiriakopoulos, A. Petralias, D. Linos, Classic primary hyperparathyroidism versus normocalcemic and normohormonal variants: do they really differ? World J. Surg. 42, 992–997 (2018). https://doi.org/10.1007/s00268-018-4512-2CrossRefPubMed

51.

C.E. Graves, C.M. McManus, J.A. Chabot, J.A. Lee, J.H. Kuo, Biochemical profile affects IOPTH kinetics and cure rate in primary hyperparathyroidism. World J. Surg. 44, 488–495 (2020). https://doi.org/10.1007/s00268-019-05157-xCrossRefPubMed

52.

F. Tassone, A. Guarnieri, E. Castellano, C. Baffoni, R. Attanasio, G. Borretta, Parathyroidectomy halts the deterioration of renal function in primary hyperparathyroidism. J. Clin. Endocrinol. Metab. 100, 3069–3073 (2015). https://doi.org/10.1210/jc.2015-2132CrossRefPubMed

53.

K. Lundstam, A. Heck, K. Godang, C. Mollerup, M. Baranowski, Y. Pernow, T. Aas, O. Hessman, T. Rosén, J. Nordenström, S. Jansson, M. Hellström, J. Bollerslev, Effect of surgery versus observation: skeletal 5-year outcomes in a randomized trial of patients with primary HPT (the SIPH Study). J. Bone Miner. Res. 32, 1907–1914 (2017). https://doi.org/10.1002/jbmr.3177CrossRefPubMed

54.

S.P. Cheng, J.J. Lee, T.P. Liu, P.S. Yang, S.C. Liu, Y.C. Hsu, C.L. Liu, Quality of life after surgery or surveillance for asymptomatic primary hyperparathyroidism: a meta-analysis of randomized controlled trials. Med. (Baltim.) 94, e931 (2015). https://doi.org/10.1097/MD.0000000000000931CrossRef

55.

S. Sho, E.J. Kuo, A.C. Chen, N. Li, M.W. Yeh, M.J. Livhits, Biochemical and skeletal outcomes of parathyroidectomy for normocalcemic (incipient) primary hyperparathyroidism. Ann. Surg. Oncol. 26, 539–546 (2019). https://doi.org/10.1245/s10434-018-6998-0CrossRefPubMed

56.

D. Lee, M.D. Walker, H.Y. Chen, J.A. Chabot, J.A. Lee, J.H. Kuo, Bone mineral density changes after parathyroidectomy are dependent on biochemical profile. Surgery 165, 107–113 (2019). https://doi.org/10.1016/j.surg.2018.04.065CrossRefPubMed

57.

J. Pepe, C. Cipriani, C. Sonato, O. Raimo, F. Biamonte, S. Minisola, Cardiovascular manifestations of primary hyperparathyroidism: a narrative review. Eur. J. Endocrinol. 177, R297–R308 (2017). https://doi.org/10.1530/EJE-17-0485CrossRefPubMed

58.

C. Blanchard, M. Mathonnet, F. Sebag, C. Caillard, C. Kubis, D. Drui, E. van Nuvel, C. Ansquer, J.F. Henry, D. Masson, F. Kraeber-Bodéré, J.B. Hardouin, R. Zarnegar, A. Hamy, E. Mirallié, Quality of life is modestly improved in older patients with mild primary hyperparathyroidism postoperatively: results of a prospective multicenter study. Ann. Surg. Oncol. 21, 3534–3540 (2014). https://doi.org/10.1245/s10434-014-3731-5CrossRefPubMed

59.

S. Bannani, N. Christou, C. Guérin, A. Hamy, F. Sebag, M. Mathonnet, P. Guillot, C. Caillard, C. Blanchard, E. Mirallié, Effect of parathyroidectomy on quality of life and non-specific symptoms in normocalcaemic primary hyperparathyroidism. Br. J. Surg. 105, 223–229 (2018). https://doi.org/10.1002/bjs.10739CrossRefPubMed

60.

P. Cunha-Bezerra, R. Vieira, F. Amaral, H. Cartaxo, T. Lima, U. Montarroyos, F. Bandeira, Better performance of four-dimension computed tomography as a localization procedure in normocalcemic primary hyperparathyroidism. J. Med. Imaging Radiat. Oncol. 62, 493–498 (2018). https://doi.org/10.1111/1754-9485.12728CrossRef

61.

H. Mazeh, H. Chen, G. Leverson, R.S. Sippel, Creation of a “Wisconsin index” nomogram to predict the likelihood of additional hyperfunctioning parathyroid glands during parathyroidectomy. Ann. Surg. 257, 138–141 (2013). https://doi.org/10.1097/SLA.0b013e31825ffbe1CrossRefPubMed

62.

E. Trébouet, S. Bannani, M. Wargny, C. Leux, C. Caillard, F. Kraeber-Bodéré, K. Renaudin, L. Chaillous, É. Mirallié, C. Ansquer, Mild sporadic primary hyperparathyroidism: high rate of multiglandular disease is associated with lower surgical cure rate. Langenbeck’s Arch. Surg. 404, 431–438 (2019). https://doi.org/10.1007/s00423-019-01782-1CrossRef

63.

T.K. Pandian, C.C. Lubitz, S.H. Bird, L.E. Kuo, A.E. Stephen, Normocalcemic hyperparathyroidism: a collaborative endocrine surgery quality improvement program analysis. Surgery 167, 168–172 (2020). https://doi.org/10.1016/j.surg.2019.06.043CrossRefPubMed

64.

I. Bossert, S. Chytiris, M. Hodolic, L. Croce, L. Mansi, L. Chiovato, G. Mariani, G. Trifirò, PETC/CT with 18 F-Choline localizes hyperfunctioning parathyroid adenomas equally well in normocalcemic hyperparathyroidism as in overt hyperparathyroidism. J. Endocrinol. Invest. 42, 419–426 (2019). https://doi.org/10.1007/s40618-018-0931-zCrossRefPubMed

65.

D.M. Carneiro, C.C. Solorzano, M.C. Nader, M. Ramirez, G.L. Irvin, 3rd: Comparison of intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: which criterion is the most accurate? Surgery 134, 973–981 (2003). https://doi.org/10.1016/j.surg.2003.06.001CrossRefPubMed

66.

T.J. Wade, T.W.F. Yen, A.L. Amin, T.S. Wang, Surgical management of normocalcemic primary hyperparathyroidism. World J. Surg. 36, 761–766 (2012). https://doi.org/10.1007/s00268-012-1438-yCrossRefPubMed

67.

M.D. Walker, S.J. Silverberg, Primary hyperparathyroidism. Nat. Rev. Endocrinol. 14, 115–125 (2018). https://doi.org/10.1038/nrendo.2017.104CrossRefPubMed

68.

B. Farford, R.J. Presutti, T.J. Moraghan, Nonsurgical management of primary hyperparathyroidism. Mayo Clin. Proc. 82, 351–355 (2007). https://doi.org/10.4065/82.3.351CrossRefPubMed

69.

M.T. Drake, B.L. Clarke, S. Khosla, Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin. Proc. 83, 1032–1045 (2008). https://doi.org/10.4065/83.9.1032CrossRefPubMed

70.

A.A. Khan, J.P. Bilezikian, A.W.C. Kung, M.M. Ahmed, S.J. Dubois, A.Y.Y. Ho, D. Schussheim, M.R. Rubin, A.M. Shaikh, S.J. Silverberg, T.I. Standish, Z. Syed, Z.A. Syed, Alendronate in primary hyperparathyroidism: a double-blind, randomized, placebo-controlled trial. J. Clin. Endocrinol. Metab. 89, 3319–3325 (2004). https://doi.org/10.1210/jc.2003-030908CrossRefPubMed

71.

R. Cesareo, E. Di Stasio, F. Vescini, G. Campagna, R. Cianni, V. Pasqualini, F. Romitelli, F. Grimaldi, S. Manfrini, A. Palermo, Effects of alendronate and vitamin D in patients with normocalcemic primary hyperparathyroidism. Osteoporos. Int. 26, 1295–1302 (2015). https://doi.org/10.1007/s00198-014-3000-2CrossRefPubMed

72.

G. Tsvetov, D. Hirsch, I. Shimon, C. Benbassat, H. Masri-Iraqi, A. Gorshtein, D. Herzberg, T. Shochat, I. Shraga-Slutzky, T. Diker-Cohen, Thiazide treatment in primary hyperparathyroidism-a new indication for an old medication? J. Clin. Endocrinol. Metab. 102, 1270–1276 (2017). https://doi.org/10.1210/jc.2016-2481CrossRefPubMed

73.

S. Brardi, G. Cevenini, T. Verdacchi, G. Romano, R. Ponchietti, Use of cinacalcet in nephrolithiasis associated with normocalcemic or hypercalcemic primary hyperparathyroidism: results of a prospective randomized pilot study. Arch. Ital. di Urol. Androl. 87, 66–71 (2015). https://doi.org/10.4081/aiua.2015.1.66CrossRef

Title: A practical approach to normocalcemic primary hyperparathyroidism
Authors: José Luis Muñoz de Nova
Miguel Sampedro-Nuñez
Isabel Huguet-Moreno
Mónica Marazuela Azpiroz
Publication date: 01-11-2021
Publisher: Springer US
Keywords: Hyperparathyroidism
Parathyroidectomy
Parathyroidectomy
Published in: Endocrine / Issue 2/2021
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-021-02845-4

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2021

Serum secreted frizzled-related protein 5 in relation to insulin sensitivity and its regulation by insulin and free fatty acids

Characteristics and outcomes of the Finnish ectopic ACTH syndrome cohort

LRH-1 high expression in the ovarian granulosa cells of PCOS patients

Hypocalcemia in COVID-19 is associated with low vitamin D levels and impaired compensatory PTH response

Extending the endocrine hypertension spectrum: novel nonclassic apparent mineralocorticoid excess

Correction: Tumor volume improves preoperative differentiation of prolactinomas and nonfunctioning pituitary adenomas

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage