{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:00:23Z","timestamp":1790744423493,"version":"4.1.0"},"reference-count":15,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2012,1,28]],"date-time":"2012-01-28T00:00:00Z","timestamp":1327708800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2012,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Primary hyperparathyroidism (pHPT), typically defined as elevated serum calcium levels associated with inappropriately elevated parathyroid hormone (PTH) levels, can occur also in patients with normal serum calcium levels. This study investigated the characteristics, workup, and surgical management of patients with normocalcemic pHPT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective chart review of a prospectively collected, single\u2010institution parathyroid database was performed on patients with sporadic pHPT who underwent parathyroidectomy between 12\/99 and 12\/08.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In all, 93 of 771 (12%) pHPT patients had normal serum calcium levels 3\u00a0months prior to surgery. Ionized calcium (iCa) levels were available for 58 patients and were elevated in 50 (86%). Among those with elevated iCa levels 90% had single\u2010gland disease (SGD), whereas 63% with normal iCa levels had SGD (<jats:italic>p<\/jats:italic> = 0.07). Preoperative imaging identified SGD in 60% of patients with normal iCa and in 66% with elevated iCa levels. Intraoperative PTH (IOPTH) monitoring identified cure in 51 of 58 (88%) patients including 6 (75%) with normal iCa. At a median follow\u2010up of 358\u00a0days, postoperative calcium and PTH levels were similar in the groups. One (1%) patient had recurrent disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Most patients with apparent normocalcemic pHPT have elevated ionized calcium levels. For patients with normocalcemic pHPT, we recommend measuring iCa levels preoperatively, performing localization studies, and utilizing IOPTH monitoring to guide a successful operation.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-012-1438-y","type":"journal-article","created":{"date-parts":[[2012,1,27]],"date-time":"2012-01-27T21:30:02Z","timestamp":1327699802000},"page":"761-766","source":"Crossref","is-referenced-by-count":61,"title":["Surgical Management of Normocalcemic Primary Hyperparathyroidism"],"prefix":"10.1002","volume":"36","author":[{"given":"Thomas J.","family":"Wade","sequence":"first","affiliation":[{"name":"Department of Surgery Medical College of Wisconsin 9200 W. Wisconsin Avenue 53202 Milwaukee WI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina W. F.","family":"Yen","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery Medical College of Wisconsin Milwaukee WI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda L.","family":"Amin","sequence":"additional","affiliation":[{"name":"Department of Surgery Medical College of Wisconsin 9200 W. Wisconsin Avenue 53202 Milwaukee WI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy S.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Surgery Medical College of Wisconsin 9200 W. Wisconsin Avenue 53202 Milwaukee WI USA"},{"name":"Division of Surgical Oncology, Department of Surgery Medical College of Wisconsin Milwaukee WI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,1,28]]},"reference":[{"key":"e_1_2_6_2_2","first-page":"1137","article-title":"A comparative study of serum ultrafiltrable, ionized, and total calcium in the diagnosis of primary hyperparathyroidism in patients with intermittent or no elevation in total calcium","volume":"104","author":"Forster J","year":"1988","journal-title":"Surgery"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0039\u20106060(05)80094\u20107"},{"key":"e_1_2_6_4_2","first-page":"185","article-title":"Ionized calcium in the diagnosis of primary hyperparathyroidism","volume":"88","author":"Monchik JM","year":"1980","journal-title":"Surgery"},{"key":"e_1_2_6_5_2","first-page":"667","article-title":"The role of ionized calcium in the diagnosis of subtle hypercalcemia in symptomatic primary hyperparathyroidism","volume":"95","author":"McLeod MK","year":"1984","journal-title":"Surgery"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0039\u20106060(97)90357\u20103"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s002689900111"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010002\u20106621\u20100"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2006\u20102802"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2004.06.037"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1590\/S0004\u201027302010000200004"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008\u20101758"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008\u20101763"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008\u20101760"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2008.06.017"},{"key":"e_1_2_6_16_2","first-page":"173","article-title":"High prevalence of normal total calcium and intact PTH in 60 patients with proven primary hyperparathyroidism: a challenge to current diagnostic criteria","volume":"28","author":"Glendenning P","year":"1998","journal-title":"Aust N Z J Med"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-012-1438-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-012-1438-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-012-1438-y","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T23:10:14Z","timestamp":1704928214000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-012-1438-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,1,28]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2012,4]]}},"alternative-id":["10.1007\/s00268-012-1438-y"],"URL":"https:\/\/doi.org\/10.1007\/s00268-012-1438-y","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,1,28]]}}}